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               Form      Information Return For Receipts of 
              MO-99 MISC Miscellaneous Income

                                                                                                                      20___
              Name                                                                          Tax Identification Number

              Address                                                     City              State                     ZIP Code
       Paid To
              * If account is for multiple payees with different surname or it includes the name of a fiduciary, trust, or estate, place an asterisk (*) by the name of the 
              individual or entity to whom the identifying number belongs.

              Name                                                                          Tax Identification Number

 Paid By      Address                                                     City              State                     ZIP Code

              Commissions and Fees to Nonemployees                        Other Fixed or Determinable Income (Specify)
               
 Income       Prizes and Awards to Nonemployees                           Rents             Royalties

                                                     E-mail:  income@dor.mo.gov                                       Form MO-99 Misc (Revised 02-2022)
Mail to:   Taxation Division
                 P.O. Box 3330                       Visit dor.mo.gov/taxation/individual/tax-types/income/ for additional information.
                 Jefferson City, MO 65105-3330
                                                     Ever served on active duty in the United States Armed Forces?  
 Phone:             (573) 751-3505                   If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible 
              Fax:  (573) 522-1762                   military individuals. A list of all state agency resources and benefits can be found at 
              TTY:   (800) 735-2966                  veteranbenefits.mo.gov/state-benefits/.