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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 (No Form W-2 Items)    Other Fixed or Determinable Income (Specify)
               
 Income       Prizes and Awards to Nonemployees (No Form W-2 Items)       Rents      Royalties

                                              E-mail:  income@dor.mo.gov                                              Form MO-99 Misc (Revised 01-2022)
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/.