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                                                                                                                        Department Use Only
                                                           Form   Missouri Department of Revenue                        (MM/DD/YY)
 MO-851                                                           Affiliations Schedule

                                                                Taxable Year Beginning                                  Ending
                                                                             (MM/DD/YY)                                 (MM/DD/YY)

                                                           Missouri Tax I.D.                                 Federal Employer
                                                           Number                                            I.D. Number

                                                           Charter
                                                           Number

                                                           Name

                                                           Number and Street                                                                         City                                                                 State         ZIP Code                                                                                    
                         Common Parent Corporation
                                                           This form must be completed by the parent corporation for itself and for corporations in the affiliated group. File Form MO-851 by attaching it to the 
                                                           Missouri consolidated tax return for the group.  
                                                                                                                                                                                                  Payments
                                                                                                                        Missouri Tax
                                                           No.               Name and Address of Corporation        Identification Number                                                  Portion of Form     Portion of Estimated 
                                                                                                                                                                                           MO-7004 Tax Payment Tax Payments
                                                                  Common Parent Corporation ...............................................................................................
                                                           Subsidiary Corporations:

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                                                           2
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                                                           5
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                                                           6
                                                  Payments                                                                 |    |    |    |    |    |    |    
                                                           7
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                                                           8
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                                                           9
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                                                           10
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                                                           11
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                                                           12
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                                                           13
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                                                           14
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Additional forms may be used, if necessary.
                                                                                                                                                                                                  Form MO-851  (Revised 12-2016)
Mail to:  Taxation Division                                                                     Phone:(573) 751-4541    Visit http://www.dor.mo.gov/business/corporate/                                         
                                                                  P.O. Box 3365                 Fax: (573) 522-1721                 for additional information.
                                                                  Jefferson City, MO 65105-3365 E-mail:  corporate@dor.mo.gov
                                                                                                 
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