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              Missouri Tax Registration Application

              You can also complete your registration online by visiting our website at 
                                   http://dor.mo.gov/registerbusiness/
                         For sales, use and withholding tax facts, sales tax rates, and FAQs,  
                                  visit our website at http://dor.mo.gov/business/.

                                                     What’s Inside . . .
              Detailed Instructions  .........................................................................................Pages 1 and 2
              Form 2643, Missouri Tax Registration Application  ...............................................Pages 3 – 6
              Bond Instructions  ..........................................................................................................Page 7
              Business Buyer Beware ................................................................................................  Page ii
              Acceptable Bond Types  ................................................................................................Page 7 

                                  Checklist for Completing Application
  -   Social security number, address, and birthdate of each owner, officer, partner, or member.
  -   Physical address and mailing address for your business.
  -   Federal Employer Identification Number (FEIN) for your business.  Visit www.irs.gov or call 1-800-829-4933
  -   Sales or use tax—You will need to know your estimated monthly sales so we can determine your filing frequency.
  -   Withholding tax—You will need to know your estimated monthly wages paid, so we can determine your withholding filing 
   frequency.
  -  Corporation or limited liability company—You should have your charter number or certificate of authority number from the 
   Missouri Secretary of State. (Most corporations and limited liability companies are required to obtain a charter number or 
   certificate of authority number to operate in Missouri.)
  -   If the business has a previous owner, you will need to know the previous owner’s name and address. If possible, please 
   provide the previous owner’s tax identification number and the purchase price.
  -   Power of Attorney (Form 2827) —If you would like to allow someone other than the listed owner(s) to sign the application 
   or handle tax matters with the Department of Revenue (Department), a Power of Attorney (Form 2827) must be completed 
   and signed by the appointee and a listed owner or member or officer and submitted to the Department with this application. 
   (Visit our website at http://dor.mo.gov/forms/ to obtain Power of Attorney (Form 2827).

  Mail the application and bond to: Missouri Department of Revenue, P.O. Box 357, Jefferson City, MO 65105-0357 or call 
  (573) 751-5860 for assistance (TTY (800) 735-2966).

              If you have questions relating to specific tax types, please refer to the following e-mail address:
                         Corporate Income Tax ..........................   corporate@dor.mo.gov
                         Sales or Use Tax ..................................   salesuse@dor.mo.gov
                         Withholding Tax ....................................   withholding@dor.mo.gov
                         Business Tax Registration ....................   businesstaxregister@dor.mo.gov

                                                                                                                                                 Form 2643 (Revised 04-2021)
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                       Business Buyer Beware
                                 Whose unpaid taxes will you be paying?
                                              Find out the facts!!!
                                 You may be liable as a successor!

•  Every person  purchasing  a business  or stock of goods  immediately  shall  notify the Director of Revenue  of the  
  business name, owner’s name, date of purchase, and type of business or stock of goods.
•  All successors or purchasers shall withhold a sufficient amount of the purchase money to cover taxes, interest, or 
  penalties due and unpaid by all former owners or predecessors, whether immediate or not, until the former owners 
  or predecessors produce a receipt from the Director of Revenue showing that they have been paid or a certificate  
  stating that no taxes are due; otherwise, the successor or purchaser shall become personally liable for the unpaid  
  tax, penalty, and interest accrued.
  Example   :Mr. Smith purchases a business from Mr. Jones for $50,000. He acquires all the inventory. He does not 
  ask Mr. Jones for a Certificate of No Tax Due. Mr. Smith comes in to apply for a Missouri Tax I.D. Number and 
  receives it. However, because Mr. Smith did not obtain a Certificate of No Tax Due from Mr. Jones, after receiving his 
  license for the business he finds Mr. Jones has sales tax delinquencies totaling $20,000, which he must pay because 
  he is now successor. Mr. Smith is now paying two people for the business — Mr. Jones and the Department.
•  All purchasers have a duty to discover whether taxes are due and unpaid by any former owner or predecessors, 
  whether immediate or not, and a lack of knowledge about successorship will not relieve a purchaser from successor 
  tax liability. Reliance on an affidavit pursuant to Missouri’s Bulk Transfer Act stating there were no creditors of the 
  business will not relieve a purchaser from successor tax liability.
Some questions you may want to ask yourself when purchasing a business:
1) Are you purchasing the building (real estate)?
2) Are you purchasing the inventory?
3) Are you purchasing the equipment?
4) Are you purchasing the fixtures?
If you answer “yes” to any of the above questions, please obtain a Certificate of No Tax Due for sales tax (or a Tax 
Clearance  if the seller  had  employer  withholding  tax or other tax types) from the seller  before  you  purchase  the  
business.
If you have any questions concerning successorship, please call (573) 751-2836 or write the Department of Revenue, 
Business Tax, P.O. Box 3390, Jefferson City, MO 65105-3390.

                                              Federal Privacy Notice
The Federal  Privacy Act requires  the Missouri  Department  of       (Chapter 32  and  143, RSMo).  In addition, statutorily provided  
Revenue (Department) to  inform taxpayers of  the Department’s        non-tax uses are:  (1) to provide information to the Department of 
legal authority for  requesting identifying information, including    Higher Education with respect to applicants for financial assistance 
social security  numbers, and to  explain why the  information is     under  Chapter 173, RSMo; and (2) to offset refunds against amounts 
needed and how the information will be used.                          due to a state agency by a person or entity (Chapter 143, RSMo).  
                                                                      Information furnished to other agencies or persons shall be used 
Chapter 143 of  the Missouri Revised Statutes  authorizes the         solely for the purpose of administering tax laws or the specific laws 
Department of Revenue to request information necessary to carry       administered by the person having the statutory right to obtain it 
out the tax laws of the state of Missouri. Federal law 42 U.S.C.      as indicated above. (For the Department of Revenue’s  authority 
Section 405 (c)(2)(C) authorizes the states to require taxpayers to   to prescribe forms and to require furnishing  of social security 
provide social security numbers.                                      numbers, see Chapters 135, 143, and 144, RSMo.)
The Department uses your social security number to identify you       You are required to provide your social security number on your tax 
and process your tax returns and other documents, to determine        return. Failure to provide your social security number, or providing  
and collect the correct amount of tax, to ensure you are complying    a false social security number, may result in criminal action against 
with the tax laws, and exchange tax information with the Internal     you.
Revenue Service, other states, and the Multistate Tax Commission  

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                                                                     Instructions

   Please review the instructions below before completing the application and if you have any questions, 
                                                       contact Business Tax Registration.

         1.  Missouri Tax I.D. Number: If you have ever been issued a Missouri Tax I.D. Number by the Missouri Department of Revenue, enter it here.   
           If you do not have one, leave this field blank.
         2.  You may be required to submit a Federal Employer Iden ti fi ca tion Number (FEIN) to complete your business registration. The FEIN is issued 
           by the Internal Revenue Service (IRS). The FEIN is used to identify taxpayers that are required to file various business tax returns. Em ployers, 
           corporations, partnerships, limited liability companies, trusts and estates, and other business entities are required to have a FEIN. For more  
           information regarding FEINs or to obtain a number online, please contact the IRS at (800) 829-4933 or visit their website at         www.irs.gov.
         5.  Ownership  Type: Check the appropriate  ownership  type for your business. Be sure to include  your charter number, certificate of 
              authority number, limited partnership number, limited liability partnership number, or limited liability number issued by the Secretary of State.  
              If you are a non-Missouri corporation, in clude the state of incorporation and date issued.
         6.  Previous Owner: If a business was previously operated at this location or you purchased any portion of the business from a previous owner, 
           You must  complete this section. Protect  yourself by obtaining a copy  of  a “No  Tax  Due”  statement  from  the  previous  owner  of  the 
           business. The Department only issues this statement if requested by the previous owner and all sales or use taxes are paid in full. See page  
           ii for Business Buyer Beware.
         7. Business Mailing Address: The Department mails reporting forms as well as confidential and non-confidential correspondence to the business 
           address listed on #4. If you want us to direct your mail to an address other than the business address for any of your taxes, enter that  
           address here and check the appropriate boxes. If this address is for a different company, please indicate that companies name.
         9.   Officers, Partners, and Mem bers: Identify all officers, partners, and members of your business who are responsible for the collection and 
           remittance of tax. If you are a sole owner and you completed the “Owner Information” on #19, you do not have to complete this section. If the 
           business is a partnership or limited liability partnership, enter all partners. If it is a limited partnership, include only the general partners. 
           If the business is owned by another corporation or LLC, please include that entity in the list of officers or members including the FEIN of that 
           corporation or LLC. Complete all information for each officer, partner, and member, including social security number and date of birth. Your 
           registration will not be complete unless we receive all requested information. Attach a list of officers, partners, and members if you cannot fit  
           them all on this page.
         10.  Authorized Representatives:  Identify  all persons who are not  a  partner, member (L.L.C),  or officer  of  the  business that  have direct 
           supervision or control over tax matters whom you authorize the Department to discuss your tax matters. All other persons must obtain  
           a Missouri Power of Attorney (Form 2827).  Complete all information for authorized  representative(s), including  social security number  
           and date of birth. Your registration will not be complete unless we receive all requested information. Attach a list if needed.
  11-14.   Sales or  Use  Tax:  Complete this  section if  you are going to  make  retail sales subject to  sales, vendor’s use,  or  consumer’s use tax. 
           Consumer’s Use Tax: Unlike sales tax, which requires a sale at retail in Missouri, use tax is imposed directly upon the person who stores, 
           uses, or consumes  tangible personal  property in Missouri. Use tax does not apply if the purchase  is from a Missouri  retailer  and 
           subject  to Missouri  sales  tax. A seller  not engaged  in business  is not required  to collect  Missouri  tax but the purchaser  in these 
           instances is responsible  for  remitting use tax  to  Missouri. If  an out-of-state  seller does not collect use tax  from  the purchaser, the 
           purchaser is responsible for remitting the use tax to Missouri. A purchaser is required to file a use tax return if the cumulative purchases  
           subject to use tax exceed $2,000 in a calendar year.
           Vendor’s Use Tax: If an out-of-state vendor makes sales of goods to a final consumer located in Missouri and the vendor has sufficient 
           nexus with Missouri, the vendor is required to collect and remit Missouri vendor’s use tax.
         11.  Retail Sales Tax License cannot be issued without a taxable begin date. If you are a seasonal business, check the months in which you 
           will make sales. We will only require you to file a return in the months you check.  
         14.  Filing Frequency: Your filing fre quency is determined by the amount of state sales tax due. Multiply your anticipated month  ly taxable sales 
           by 4 percent to arrive at your estimated monthly liability.
         15. Business Name and Phys i cal Location:    Enter all information regarding the physical location of your business, including your business name. 
           Do not use a PO Box or Rural Route Number for this address.       If you make retail sales, this is the address we will print on your license. If you  
           have more than one location, attach a sheet listing the additional locations.
         16.  If sales will be made from various temporary locations, (for example, craft shows), provide the list of these locations. If you do not know 
              where your next location will be, a general location will be used for registration purposes. As soon as you know the location where your 
              sales will take place, please notify the Department at businesstaxregister@dor.mo.gov or call (573) 751-5860.
  17-19.  City Limits or District(s): Determine whether you are inside a city’s limits or a district(s).  If you are registering for sales tax, this will ensure 
           we register you to collect and remit the correct tax rate.

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      20.  Retail Sales of Certain Items.
          r  Food Tax: Food or food products for home consumption.  http://dor.mo.gov/business/sales/foodtax.php.
      Lamar Heights
          r  Section 94.838, RSMo, adds an additional 2% tax to the sales tax rate if you are a restaurant, café, cafeteria, or lunchroom within the Lamar Heights.
      Branson 1% Exemption
          r  Section 94.802, RSMo, reduces the 1% Branson/Lakes Area Tourism Enhancement District Sales Tax to 0% for hotels and amusement
             within the municipality.
      Branson 1/8% Exemption
          r  Section 94.802, RSMo, Branson bushiness defined within this section, include Branson/Lakes Area Tourism Enhancement District sales  
             tax is reduce to 7/8%. 
          r  Section 144.049, RSMo, exempts certain back-to-school purchases, such as clothing, school supplies, computers, and other items as defined 
             by the statute, during a period from 12:01 a.m. the first Friday in August and ending at midnight on the Sunday following.
          r  Beginning in calendar year 2009, Section 144.526, RSMo, exempts up to $1,500 for certain Energy Star certified appliance purchases, such 
             as furnaces, clothes washers and dryers, water heaters, trash compactors, dishwashers, conventional ovens, ranges, stoves, air conditioners, 
             refrigerators and freezers and other items as defined by the statue, during a period from 12:01 a.m. on April 19th and ending at midnight  
             on April 25th.
          r  A fifty cent (.50) tire fee applies to the retail sale of all new tires designed for use on trailers and self-propelled vehicles not operated 
             exclusively on tracks. A fifty cent (.50) battery fee applies to the retail sale of batteries that contain lead and sulfuric acid with a nominal  
             voltage of at least six volts and are intended for use in motor vehicles and watercraft.
          r  Section 144.054.2     exempts from state sales tax, state use tax and local use taxes (local sales taxes still apply) electricity, gas, whether 
             natural, artificial, or propane, water, coal, and energy sources, chemicals, machinery, equipment, and materials used or consumed in the 
             manufacturing, processing, compounding, mining, or production of any product; used or consumed in processing recovered materials;  
             or used or consumed in research and development related to manufacturing.
      23. Motor Vehicle  Leasing  Sales  Tax: Indicate  whether  or not your company  will  lease  motor vehicles  that were  purchased  tax exempt 
        because the exemption for motor vehicles purchased  for leasing was claimed. Your company will be responsible  for charging  the 
        retail sales rate of tax where the lessee is located. (This includes leases that are completed between a Missouri dealer, as your agent, and  
        a Missouri customer, even if your out of state company is carrying the lease).
        Motor Vehicle Leases from Out of State: Indicate if your company is an out of state company that leases motor vehicles to a Missouri 
        resident where the lease is entered into outside Missouri and the motor vehicle is delivered to the lessee outside Missouri. Your company 
        will be responsible for charging the highway sales tax rate where the lessee is located. You will need to provide a list of the lessee’s locations  
        in Missouri.
  24-28.    Out-of-State Businesses: Only out-of-state businesses need to complete this section. It helps us determine whether you should report 
        sales tax, use tax, or withholding tax.
    29-31.   Corporate Income or Franchise Tax: Businesses taxed as a corporation by the Internal Revenue Service must complete this section. 
   32-35.  Withholding Tax: The withholding tax filing frequency is based upon the amount of withholding tax you will be remitting to the De partment. 
        If you will be remitting over $9,000 in withholding tax per month, you are required to pay quarter-monthly (weekly). Your payment(s) should 
        be sent to the De part ment electronically.  Currently, there are two methods available for electronic filing and payment:
                1.)  ACH credit through the Department’s TXP bank project; and 
                2.)  Internet filing through a MyTax Missouri portal account, or business tax guest filing.
        For information on electronic filing through ACH credit, visithttp://dor.mo.gov/business/electronic.php, send an e-mail toelecfile@dor.mo.gov ,
          or call (573) 751-3900. For information on electronic filing through the Internet, visit https://mytax.mo.gov.
      36.   Courtesy Mailing Address: We will mail certain duplicate withholding notices to an address other than your mailing address (for example, 
          owner address).
     37.  Transient Employer: If de fined as a transient em ployer pursuant to Title XVIII, Chapter 285.230, RMSo, please calculate the amount of your 
        bond. If you are unsure if you qualify as a transient employer or require transient employer bond forms, please contact the Taxation Division,  
        P.O. Box 357, Jef fer son City, MO 65105-0357 or call (573) 751-0459 (TTY (800) 735-2966).
        Signature:  An owner, officer, partner, member or responsible party must sign the application and be listed as an owner.  If a power of attorney 
        signs the application, you must include a Power of Attorney (Form 2827) signed by an owner listed on the application.
        Confidentiality: To ensure your tax records are protected and confidential, the De part ment will not release tax information to anyone who is 
        not listed in our records as an owner, partner, member, or officer for your business. If your partners, members, or officers change, you must 
        update your registration with the Department by completing Registration or Exemption Change Request (Form 126), before we can release 
        tax information to those new partners, members, or officers. If you would like the Department to release tax information to an accountant, 
        tax preparer, or another individual who is not listed on your account, please complete a Power of Attorney Form. (Visit our website at  
          http://dor.mo.gov/forms/ to obtain Power of Attorney ( Form 2827   ).

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      0 0 0 1 1 1 1 0 
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1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 51 
      0 0 0  4 4 4 4 0                                                                                                                       Department Use Only
      0 0 0  5 5 5 5 0                    Form                                                                                               (MM/DD/YY)
      0 0 0  6 6 6 6 0                                  Missouri Tax Registration Application
      0 0 0  7 7 7 7 0                   2643
      0 0 0  8 8 8 8 0 
      0 0 0  9 9 9 9 0 
      1 1 1  0  0  0  0  1 Missouri Tax I.D.  
                           Number                                                                                                 Federal Employer
      1 1 1  1 1 1 1 1     (Optional)                                                                                             I.D. Number
      1 1 1  2 2 2 2 1                                          Answer all questions completely.  Incomplete and unsigned applications will delay processing.                                        .
      1 1 1  3 3 3 3 1 
      1 1 1  4 4 4 4 1                   3.  Select all tax types for which you are applying:                                                                                         r  New MO Registration
                                         Sales from a Missouri business location
      1 1 1  5 5 5 5 1                                                                                           Missouri Employer Withholding Tax                                    r  Purchase of Existing Business
      1 1 1  6 6 6 6 1                   r  Retail Sales                                                         r    Regular Withholding                                             r  Reinstating Old Business 
      1 1 1  7 7 7 7 1                   r  Temporary Retail Sales (Less than 191 days)                          r    Domestic or Household Employee                                  r  Converted (must have converted
      1 1 1  8 8 8 8 1                   r  Retail Liquor or Alcohol Sales                                       r  Transient Employer*                                                  through the Missouri Secretary of 
                                         Sales or Purchases from an out-of-state location
      1 1 1  9 9 9 9 1                                                                                           Corporate Tax                                                           State’s office)
      2 2 2  1 1 1 1 2                   r     Vendor’s Use
      2 2 2  0 0 0 0 2                                                                                           r    Corporate Income                                                r  Court Appointed Receiver
                                                                                                                                                                  Reason for Applying r  Other:
      2 2 2  2 2 2 2 2     Reasonr             Consumer’sfor ApplicationUse (Missouri purchases                  r    Corporate Franchise
                                               where tax is not collected.)
      2 2 2  3 3 3 3 2                       * Sales & Use Tax bond not required unless requested by The Department of Revenue
      2 2 2  4 4 4 4 2                       ** Bond required for Transient Employer
      2 2 2  5 5 5 5 2 
                                         4. Owner Name (Enter Corporation, LLC or Partnership Name, if applicable)
      2 2 2  6 6 6 6 2 
      2 2 2  7 7 7 7 2                   Address                                                                                       E-mail Address
      2 2 2  8 8 8 8 2 
      2 2 2  9 9 9 9 2                   City                                                                        State             ZIP Code                                        County
      3 3 3  0 0 0 0 3 
      3 3 3  1 1 1 1 3                   If an individual is listed as the owner, you must also provide the following: 
      3 3 3  2 2 2 2 3     OwnerSocialInformationSecurity Number                                                 Date of Birth (MM/DD/YYYY)               Telephone Number
      3 3 3  3 3 3 3 3                        |        |        |        |        |        |        |        |   ___ ___ / ___ ___ / ___ ___ ___ ___      (___ ___ ___) ___ ___ ___-___ ___ ___ ___
      3 3 3  4 4 4 4 3 
      3 3 3  5 5 5 5 3                   5. Ownership Type               r Sole Proprietor                     r Partnership         r Government         r Trust 
      3 3 3  6 6 6 6 3                       All ownership types listed below, unless specifically exempted, are required to be registered with the Missouri Secretary of State’s Office (register 
      3 3 3  7 7 7 7 3                       at sos.mo.gov or call (866) 223-6535).  Your application will not be complete without providing the charter number issued to you by their office.
      3 3 3  8 8 8 8 3 
                                             r   Limited Partnership - LP Number  __________________________________ 
      3 3 3  9 9 9 9 3                                                                                                                                r   Not Required to register with Missouri Secretary
                                                                                                                                                          of State
      4 4 4  0 0 0 0 4                       r   Limited Liability Partnership - LLP Number ___________________________ 
      4 4 4  1 1 1 1 4                                                                                                                                r Other
                                             r   Limited Liability Company - LLC Number ____________________________ 
      4 4 4  2 2 2 2 4 
      4 4 4  3 3 3 3 4                           Taxed as a              r Disregarded Entity                  r Partnership     r Corporation 
                           Ownership Type
      4 4 4  4 4 4 4 4                       r   Missouri Corporation - Missouri Charter No.  _________________________                                
      4 4 4  5 5 5 5 4                           Date Incorporated (MM/DD/YYYY)  ___ ___ / ___ ___ / ___ ___ ___ ___ 
      4 4 4  6 6 6 6 4 
                                             r   Non-Missouri Corporation - Missouri Charter No. ______________________ 
      4 4 4  7 7 7 7 4 
                                                 State of Incorporation _________________________   Date Registered in Missouri (MM/DD/YYYY)  ___ ___ / ___ ___ / ___ ___ ___ ___
      4 4 4  8 8 8 8 4 
      4 4 4  9 9 9 9 4                   6. Is there a previous owner or operator for the business?                   r Yes*       r   No    *If yes, the following section must be completed.
      4 4 4  0 0 0 0 4 
      5 5 5  1 1 1 1 5                    Select any of the following that you purchased from the previous owner:                     r Inventory   r Fixtures   r Equipment   r Real Estate
      5 5 5  2 2 2 2 5 
      5 5 5  3 3 3 3 5                    r Other __________________________________________________________________________________________________________
      5 5 5  4 4 4 4 5                                 _____________________________________________________________________ Purchase Price
      5 5 5  5 5 5 5 5 
                                         Name of Previous Owner or Operator                                                                               Missouri Tax Identification Number 
      5 5 5  6 6 6 6 5 
      5 5 5  7 7 7 7 5                                                                                                                                           |        |        |        |        |        |        |        
                                         Physical Location of Previous Business                                                  City                                                  State             ZIP Code
      5 5 5  8 8 8 8 5 
      5 5 5  9 9 9 9 5     PreviousAddress ofOwnerPreviousInformationBusiness                                                    City                                                  State             ZIP Code
      5 5 5  0 0 0 0 5 
      6 6 6  1 1 1 1 6 
      6 6 6  2 2 2 2 6                                                                                         *14605010001*
      6 6 6  3 3 3 3 6                                                                                                     14605010001
      6 6 6  4 4 4 4 6                                                                                                           3
      6 6 6  5 5 5 5 6 
      6 6 666 6 6 6 



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Reporting forms and notices will be mailed to this address.
7. Address (street, rural route or P.O. Box) City State ZIP Code

Company Name if different than owner

Which forms do you want mailed to this address?
 r All Tax Types       r Sales and Use Tax       r Corporate Income Tax       r Employer Withholding Tax
Address where you will store your tax records (do not use a P.O. Box for record storage).
8. Physical Address City State                ZIP Code
Mailing and Storage Address
9. Provide the officers, partners, or members (L.L.C.) of your business who are responsible for the collection and remittance of tax. 
 Listing individuals or entities here indicates they have direct supervision or control over tax matters.  Attach list if needed.
Name (Last, First, Middle Initial)     Title

Social Security Number    Federal Employer ID Number (FEIN) Date of Birth (MM/DD/YYYY)
        |        |        |        |        |        |        |        |                       |        |        |        |        |        |        |        |              ___ ___/___ ___/___ ___ ___ ___
Home Address     City

State  ZIP Code   County  Title Begin Date (MM/DD/YYYY)
___ ___/___ ___/___ ___ ___ ___
Name (Last, First, Middle Initial)     Title

Social Security Number    Federal Employer ID Number (FEIN) Date of Birth (MM/DD/YYYY)
Officers, Partners, or Members         |        |        |        |        |        |        |        |                       |        |        |        |        |        |        |        |              ___ ___/___ ___/___ ___ ___ ___
Home Address     City

State  ZIP Code   County  Title Begin Date (MM/DD/YYYY)
___ ___/___ ___/___ ___ ___ ___
10.  Business Tax Accounts:  Identify all persons who are not a partner, member (L.L.C), or officer of the business that have direct supervision or  
 control over tax matters whom you authorize the Department to discuss your tax matters.  Attach list if needed.
Title Begin or End Date (MM/DD/YYYY)  Name (Last, First, Middle Initial)
__ __ / __ __ / __ __ __ __
Title Social Security Number Birthdate (MM/DD/YYYY)
      |        |        |        |        |        |        |        |        __ __ / __ __ / __ __ __ __
Home Address
Representatives
City       State ZIP Code  County

11. Taxable Sales or Purchases Begin Date (MM/DD/YYYY)  ___ ___/___ ___/___ ___ ___ ___
12. Temporary License (Less than 191 days) (MM/DD/YYYY)
 (Example: fireworks, temporary event, etc.)   Begins ___ ___/___ ___/___ ___ ___ ___       Ends ___ ___/___ ___/___ ___ ___ ___
13. Seasonal Business: If you do not make taxable sales year round, please check the months that you do.
 r January  r February  r March  r April  r May  r June  r July  r August  r September  r October  r November  r December
14. Estimated sales and use tax liability (select one).  Your selection will determine your return filing frequency.
 r Monthly (over $500 a month)         r Quarterly ($500 or less a month)         r Annually (less than $100 a quarter)

Retail Sales, Consumer’s or Vendor’s Use Tax

*14605020001*
14605020001
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 15. Business Name (DBA name: attach list if necessary for additional locations)

Street, Highway (Do not use P.O. Box Number or Rural Route Number) City 

County State ZIP Code Business Telephone Number
(___ ___ ___) ___ ___ ___-___ ___ ___ ___
 16. Will sales be made at various temporary locations in Missouri? 
 r No    r Yes—Attach a list of all known locations. If no Missouri location is given during initial registration, a general location will be used.
17. Is this business located inside the city limits of any city or municipality in Missouri? 
 To verify go to https://mytax.mo.gov/rptp/portal/home/business/salesUseTaxRateInformation
 r No   r Yes — Specify the city: ______________________________________________________________________ ___
18. Is this business located inside a district(s)?  For example, ambulance, fire, tourism, community or transportation development.
    r No   r Yes Specify the district name(s):   ________________________________________________________________
19. Describe the business activity, stating the major products sold and services provided. ___________________________________________
Business Name and Physical Location
_________ _______________________________________________________________________________________________________
 r Retail _____%    r Wholesale _____%    r Service  _____%   r Manufacturer   r Contractor   r Other _______________

20. Do you make retail sales of the following items?  Select all that apply.        
 r Alcoholic Beverages    r Alternative Nicotine    r Branson Hotel-Amusement Exemption   r Branson Restaurant & Drink Exemption
 r Cigarettes or Other Tobacco Products r Domestic Utilities  r E-Cigarettes or Vapor Products  r Food Subject to Reduced State Food Tax Rate
 r Items Qualifying for Show Me Green Sales Tax Holiday 
 r Items Qualifying for Back-To-School Sales Tax Holiday  http://dor.mo.gov/business/sales/taxholiday/
 r Lamar Heights Additional Restaurant Tax  r Lead-Acid Batteries      r New Tires    r Post-Secondary Educational Textbooks  
 r Telecommunication Services
  r Qualifying Utilities or Items Used or Consumed in Manufacturing or Mining, Research and Development, or Processing Recovered Materials.
21. Do you make retail sales of aviation jet fuel to Missouri customers? ........................................................................................... r Yes r No
 If yes, are your sales made at:
 r A Missouri airport?       r A location outside Missouri and the fuel is transported into Missouri?
Business Activity  If yes, is the airport located in Missouri and identified on the National Plan of Integrated Airport Systems (NPIAS)? ................ r Yes r No
 If yes, provide a list of applicable locations.  _____________________________________________________________________________
22. Do you use, store, or consume aviation jet fuel in Missouri where the seller does not collect tax? ............................................. r Yes r No
 If yes, is the fuel stored, used, or consumed in an airport that is identified on the NPIAS? ......................................................... r Yes r No
 If yes, provide a list of applicable locations:  _____________________________________________________________________________
23. Do you lease or rent motor vehicles that were purchased sales tax exempt, to Missouri customers? ........................................ r Yes r No
 If you are an out-of-state company, will you lease motor vehicles to a Missouri resident where the lease is entered into 
 outside Missouri and the motor vehicle is delivered outside Missouri? ........................................................................................ r Yes r No

If you are an out-of-state entity doing business in Missouri, please answer the following questions.  .
24.  Do you have a location or job site in Missouri? .......................................................................................................................... r Yes r No
  If yes, attach a list of your locations including address, city, state, zip code and indicate if the location is inside or outside 
 the city limits.  ____________________________________________________________________________________________________
25.  Are orders taken from your Missouri customers by telephone, non-resident salesmen, etc.?  If resident salesmen, attach 
a list where they live and indicate if they are inside or outside the city limits............................................................................. r  Yes r No
26.  Do your representatives who reside in Missouri: 
A.  Approve customer orders? ..................................................................................................................................................... r Yes r No 
B.  Make on the spot sales? ........................................................................................................................................................ r Yes r No 
C.  Maintain an inventory? ........................................................................................................................................................... r Yes r No 
D.  Deliver merchandise to the customer? .................................................................................................................................. r Yes r No
Out-of-State Company 27.  Do you have non-resident representatives, agents, or temporary employees coming into Missouri on a regular basis? ......... r Yes r No
If yes, define the activities performed while in Missouri.  ___________________________________________________________________  
  ___________________________________________________________________________________________________
28.  Do you have real or tangible personal property in Missouri? ..................................................................................................... r Yes r No 
If yes, please describe: ___________________________________________________________________________________

*14605030001*
14605030001
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                          29. Is this corporation registered with the Internal Revenue Service as a    r Regular or Close Corporation    r Sub Chapter S Corporation

                          30. Corporation Tax Begin Date in Missouri (MM/DD/YYYY)                          Corporation Taxable Year End (MM/DD)
                               ___ ___/___ ___/___ ___ ___ ___                                             ___ ___/___ ___
                          31. Will the corporation be required to make quarterly estimated Missouri income tax payments?  If the Missouri estimated 
 Corporate Income Tax       tax is expected to be at least $250, or 6.25% of the Missouri taxable income, check the “Yes” box. ......................................                                                               r Yes r No

                          32. Missouri Withholding Begin Date (MM/DD/YYYY)                                 How many of your employees will work in Missouri?
                              ___ ___/___ ___/___ ___ ___ ___
                          33. Estimated employer withholding tax liability (select one).  Your selection will determine your return filing frequency.
                              Estimated monthly gross wages _____________________ X 5.4% = __________________________
                              r Annually (less than $100 withholding tax per quarter)                     r Monthly ($500 to $9,000 withholding tax per month)
                              r Quarterly ($100 withholding tax per quarter to $499                       r Quarter-Monthly (weekly) (over $9,000 withholding tax per month; required
                                 per month)                                                                to pay electronically)
                          34. Does a parent company file withholding tax reports and receive full compensation for timely filed returns? ...................................                                                        r Yes r No
                          35. If you do not pay wages year round, please check the months that you do pay wages.
                           r January  r February  r March  r April  r May  r June  r July  r August  r September  r October  r November  r December
                          Withholding Tax Courtesy Mailing Address (a copy of all withholding tax delinquent notices will be mailed to this address)
                          36. Business Name (DBA name)

                          Street, Route or P.O. Box                                                         City 

                          County                                              State                         ZIP Code                        Business Telephone Number
                                                                                                                                            (___ ___ ___) ___ ___ ___-___ ___ ___ ___
                          Transient Employer
                          37. Are you a transient employer?   ..................................................................................................................................................................... r Yes r No 
                              An employer not domiciled in Missouri and temporarily transacting business in Missouri for less than 24 consecutive months is defined as a transient employer.     
 Employer Withholding Tax     (Example: contractor, temporary staffing agency, etc.). For additional information, contact the Department at businesstaxregister@dor.mo.gov or call 
                              (573) 751-0459. If you have indicated that you are a transient employer, you must complete the entire Employer Withholding Tax Section above.
                              A transient employer must submit the following with this application:                                           Missouri Employment Security Account Number 
                              • A completed insurance certification slip indicating Missouri as a covered state for worker’s compensation
                              • Missouri Employment Security Account number, if hiring a Missouri resident: (first seven digits required)
                              • Your Missouri Certificate of Authority Number issued by the corporate division of the Missouri Secretary of State’s Office
                              • A Transient Employer Bond not less than $5,000
                          Calculate your transient employer bond:
                          A. Missouri withholding tax        Monthly gross wages _______________________  X 5.4% = _____________________ X 3 = ____________________________ (a)
                          B. Missouri unemployment tax   Average # of workers __________ X $7,000 = __________________ X 3.38% __________________ / 4 = ___________________ (b)
                          (a) ___________________________ + (b) ___________________ = ______________________________ (amount of bond - minimum $5,000)
                          Visit http://dor.mo.gov/forms/index.php?category=13 for bond forms.
                          Type of bond  r Cash Bond (Form 332)   r Certificate of Deposit (Form 4172)  r Irrevocable Letter of Credit (Form 2879)  r Surety Bond (Form 331)      

                          Comments:

                          Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. This application must be signed by the owner, if the business 
                          is a sole proprietorship, or by an individual listed in the Officer, Partners, or Members section of this application. The signing party is acknowledging that they have direct supervision or 
                          control over tax matters.
                          Signature                                                                 Title                                                 Date (MM/DD/YYYY)
                                                                                                                                                          ___  ___ / ___  ___ / ___  ___  ___  ___
                          Typed or Printed Name                                                     E-mail Address
         Signature
                           Confidentiality of Tax Records
                          Missouri Statute 32.057, RSMo, states that all tax records and information maintained by the Missouri Department of Revenue are confidential. The tax information can 
                          only be given to the owner, partner, member, or officer who is listed with us as such. If you wish to give an employee, attorney, or accountant access to your tax information, 
                          you must supply the Department with a power of attorney to grant the authority to release confidential information to them. Visit http://dor.mo.gov/forms to obtain a 
                          Power of Attorney (Form 2827).
                                                                                                                                                                   Form 2643 (Revised 04-2021)
Mail to:  Taxation Division                                      Phone: (573) 751-5860                                                               Visit 
                              P.O. Box 357                       Fax: (573) 522-1722                                      http://dor.mo.gov/business/register/ 
                              Jefferson City, MO 65105-0357      E-mail:  businesstaxregister@dor.mo.gov                                    for additional information.

                                                                  *14605040001*
                                                                                         14605040001
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                                                          Transient Employer: Missouri  Statute 285.230, RSMo, a transient employer must file a bond with the Department unless they meet all the exemption 
                                                             criteria listed in 285.230(2). The amount of bond shall not be less than the average estimated quarterly withholding  and unemployment  tax  
                                                             liabilities of the employer and in no case less than $5,000 nor more than $25,000.
                                                          ***  Important: If you are a transient employer and fail to file a bond, you are in violation of Missouri law. You may be guilty of a misdeameanor and 
                                                             penalized up to $5,000 and will not be able to perform work in Missouri.
                                                          *** Sales & Use Tax bonds are only required if requested by The Department of Revenue.
                                                          Cash Bond (Form 332)
                                                            1.   Fully complete the cash bond form.  Owners name must include owner, all partners, corporation, or LLC name.
                                                            2.  Sign the cash bond form.
                                                            3.   Forward a cashier’s check, money order, or certified check with the cash bond form. Cash, personal, or company checks are not acceptable.
                                                          Surety Bond (Form 331)
                                                            1.  Owners name must include owner, all partners, corporation, or LLC name.
                                                            2.  A surety bond must be issued by an insurance company licensed for bonding with the Department of Insurance, State of Missouri.
                                                            3.  It must be on the form provided by the Department.
                                                            4.  The form must bear the effective date.
                                                            5.  It must be signed by an authorized representative of the surety company and the owner, partner, officer, or member.
                                                             6. The Surety Bond must be accompanied by a valid Power of Attorney letter, issued by the surety company, authorizing the surety official to sign  
                                                             the Surety Bond.
                                                            7.  It must be the original bond.  A copy is not acceptable.
                                                          Irrevocable Letter of Credit (Form 2879)
                                                            1.   Owners name must include owner, all partners, corporation, or LLC name.
                                                            2.  The letter of credit must be issued by a financial banking institution located in the United States.
                                                            3.  It must be on the form provided by the Department.
                                                            4.  It must be the original letter of credit. A copy is not acceptable. 
                                                            5.  It must state the owner’s name. 
                                                            6.  It must state the date of issuance.
                                                            7.  It must be signed by a bank official and notarized.
                                                            8.   It must be accompanied by an “Authorization for Release of Confidential Information” form which must be signed by the owner, partner, officer, or 
                                                             member and notarized. 
                                                          Certificate of Deposit (Form 4172)
                                                            1.  The Certificate of Deposit must be issued by a state or federally chartered financial institution.
                                                            2.   The Certificate of Deposit must be issued in the name of the Missouri Department of Revenue and the owner, all partners, corporation name or 
                                                             limited liability company name.
Sales and Use Tax and Transient Employer Bond Information   3.  It must be issued for not less than 24 months.
                                                            4.  It must be accompanied by the “Assignment of Certificate of Deposit” form provided by the Department which must be completed by the        
                                                             financial institution.
                                                            5.  The Certificate of Deposit must be endorsed or accompanied by a signed withdrawal slip.
                                                            6.  The actual Certificate of Deposit, Assignment of Certificate of Deposit, and a copy of the signature  card must be forwarded  with the  
                                                             registration application.

                                                                                                                                                                                    Form 2643 (Revised 04-2021)

                                                                                                      *14000000001*
                                                                                                                        14000000001
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