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                                                                                Missouri Department of Revenue                         Department Use Only
                                                                      Form      Tax Increment Financing                                (MM/DD/YY)
 MO-WTIF
                                                                                Net New Job Salary Report
                                                                                                                                                    Reporting Period
                                                                                                                                                    (MM/YY)

Missouri Tax I.D.                                                                                                       Federal Employer
Number                                                                                                                  I.D. Number
Business Name                                                                                                           Owner’s Name

Reporting Location Street Address                                                                                       City                              State                                   Zip Code  
 
TIF or MODESA Name (Assigned by Missouri Department of Economic Development)                                                 Did you electronically file your MO-941 return for this tax period? 
                                                                                                                                     r Yes     Nor
                                                                           Annual Gross       Number of Net Full-Time   Average Gross                      Department Use Only
                                                                           Salary Range       Equivalent Employees      Annual Salary                 Income Tax Percentage                       Increment Payment
                                                                      Less than $5,000                                $                                         %                                 $
                                                                      $5,000 - $9,999                                 $                                         %                                 $
                                                                      $10,000 – $14,999                               $                                         %                                 $
                                                                      $15,000 - $19,999                               $                                         %                                 $
                                                                      $20,000 - $24,999                               $                                         %                                 $
                                                                      $25,000 - $29,999                               $                                         %                                 $
                                                                      $30,000 - $34,999                               $                                         %                                 $
                                                                      $35,000 - $39,999                               $                                         %                                 $
                                                                      $40,000 - $44,999                               $                                         %                                 $
                                                                      $45,000 - $49,999                               $                                         %                                 $
                                                                      $50,000 - $54,999                               $                                         %                                 $
                                                                      $55,000 - $59,999                               $                                         %                                 $
                                                                      $60,000 - $64,999                               $                                         %                                 $
                              Net New Job Salary Information
                                                                      $65,000 - $69,999                               $                                         %                                 $
                                                                      $70,000 - $74,999                               $                                         %                                 $
                                                                      $75,000 - $99,999                               $                                         %                                 $
                                                                      $100,000 - $199,999                             $                                         %                                 $
                                                                      $200,000 - $499,999                             $                                         %                                 $
                                                                      $500,000 -$1,000,000                            $                                         %                                 $
                                                                      Greater than $1,000,000                         $                                         %                                 $
                                                                      Your completed MO-941 must accompany this form unless electronically filed.               Total                             $
                                                                      Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
                                                                      Signature                                                                Title

                                                            Signature Printed Name                                                             Date (MM/DD/YYYY)
                                                                                                                                                  __ __ /__ __ /__ __ __ __
                                                                                                                                                                           Form MO-WTIF (Revised 12-2014)
Mail to:  Taxation Division                                                                              Phone: (573) 751-8741
                                                                           P.O. Box 3375                 TTY: (800) 735-2966                      *14205010001*
                                                                           Jefferson City, MO 65105-3375 Fax: (573) 522-6816                                    14205010001
                                                                                                         E-mail:  withholding@dor.mo.gov