Department Use Only
Form (MM/DD/YY)
Transient Employer Missouri
2643T Tax Registration Application
Missouri Tax I.D.
Number Federal Employer
(Optional) I.D. Number
If you will be making sales in Missouri, you must fill out a, Missouri Tax Registration Application (Form 2643).
Before the Department can process your transient employer application, you must provide the following with this application:
r A completed insurance certification document indicating Missouri as a covered state for Workers’ Compensation;
r If hiring a Missouri resident, you will need your Missouri Employment Security Account Number issued by the Missouri Department of
Labor (573) 751‑3571;
Checklist
r Your Missouri Certificate of Authority Number issued by the corporate division of the Missouri Secretary of State’s Office
(866) 223‑6535; and
r A Transient Employer Bond not less than $5,000, not more than $25,000.
Answer all questions completely. Incomplete and unsigned applications will delay processing.
3. Missouri Employment Security Account number, if hiring a Missouri resident: (first seven digits required ) ... | | | | | | | | | |
r
4. Select all tax types for which you are applying: New MO Registration
r Purchase of Existing Business
r Transient Employer Withholding Tax (Bond Required) r Reinstating Old Business
r Corporate Income Tax r Converted (must have converted
through the Missouri Secretary of
r Corporate Franchise Tax State’s office)
r Consumer’s Use Tax (Use tax is imposed on the storage, use, or consumption of tangible r Court Appointed Receiver
personal property in this state. You must pay consumer’s use tax on tangible personal
property stored, used, or consumed in Missouri unless you paid sales or use tax to the r Other:
Reason for Application seller or the property is exempt from tax.) Reason for Applying
5. Owner Name (Enter Corporation, LLC or Partnership Name, if applicable)
Address E‑mail Address
City State ZIP Code County
Owner Information If an individual is listed as the owner, you must also provide the following:
Social Security Number Date of Birth (MM/DD/YYYY) Telephone Number
___ ___ /___ ___ /___ ___ ___ ___ (___ ___ ___) ___ ___ ___-___ ___ ___ ___
6. Ownership Type r Sole Proprietor r Partnership r Government r Trust
All ownership types listed below, unless specifically exempted, are required to be registered with the Missouri Secretary of State’s Office (register
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.
r Limited Partnership ‑ LP Number __________________________________
r Limited Liability Partnership ‑ LLP Number ___________________________ r Not Required to register with Missouri Secretary
of State
r Limited Liability Company ‑ LLC Number ____________________________
Taxed as a r Disregarded Entity r Partnership r Corporation r Other
Ownership Type r Missouri Corporation ‑ Missouri Charter No. _________________________
Date Incorporated (MM/DD/YYYY) ___ ___ /___ ___ /___ ___ ___ ___
r Non‑Missouri Corporation ‑ Missouri Charter No. __________________
State of Incorporation _________________________ Date Registered in Missouri (MM/DD/YYYY) ___ ___ /___ ___ /___ ___ ___ ___
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