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                                                                                                                                 Department Use Only
                                                Form                                                                             (MM/DD/YY)
                                                      Irrevocable Letter of Credit
                                        2879
                                                                                                                                              Please print on white paper only

Missouri Tax I.D.  
Number                                                                                                            Federal Employer
(Optional)                                                                                                        I.D. Number

                                                    r Sales and Use Tax (If required by The Department of Revenue)                         r Cigarette Tax         r Motor Fuel Tax
                                    Tax     Type
                                                    r Other Tobacco Products                 r Transient Employer Withholding and Unemployment Tax

Amount (U.S. Currency)                                                                    Letter of Credit Number                                     Date of Issuance (MM/DD/YYYY)
                                                                                                                                                      __ __ / __ __ / __ __ __ __
At the request of Taxpayer or Business (Owner’s name), all Partners, Corporation, or LLC Name

Taxpayer or Business Owner’s Address                                                                                         City

County                                                                    State                ZIP Code                      E-mail Address

___________________________________________________________________________________(Issuer) 
hereby issues this Irrevocable Letter of Credit (ILC) in favor of the Missouri Department of Revenue, in the aggregated sum of
________________________________________________________________________________________________ dollars
($__________________________).  This ILC shall secure the payment of the above indicated tax and related fees, interest, 
additions to tax, and penalties due the state of Missouri on or after the date this ILC is issued.
The funds shall be paid to the Department upon a written demand for payment on the Issuer referencing this ILC.  A demand for any 
payment shall be sent by U.S. mail or personal service.  The Issuer shall upon receipt honor all partial or full demands for payment 
and make payment to the Department within thirty (30) days of receipt of the demand.
This ILC shall be effective for a period of one year from the date of issuance and shall automatically renew for additional one-year 
periods unless at least sixty (60) days prior to any such expiration date the Issuer notifies the Department in writing at the address 
indicated for each type of tax shown above that it does not elect to renew this ILC.  Any election not to renew the ILC shall not 
operate to relieve, release or discharge the Issuer from any liability for the indicated tax or taxes and related fees, interest, additions 
to tax, and penalties of the taxpayer or business that may accrue for all periods prior to the cancellation of the ILC.
The Department shall have a period of one year after the expiration date of the ILC to make a demand for payment upon the Issuer.  
The Issuer affirms that any demand for payment made by the Department in accordance with the terms of this ILC shall be honored 
upon receipt.
This agreement and any legal action pertaining thereto shall be governed by and construed in accordance with these terms and the 
laws of the State of Missouri.  The parties understand and agree that the exclusive jurisdiction for any action concerning this ILC shall 
be the state of Missouri and the only venue shall be in the Circuit Court of Cole County, Missouri.  The Issuer understands and agrees 
that it shall be liable for prejudgment interest and attorney fees if it breaches its obligations under this ILC.
The person signing this ILC states that he or she has the legal authority to enter into this ILC and to legally bind the taxpayer or 
business below.
                                                    Issuing Bank or Financial Institution      Address 

                                                    City, State, Zip Code                                                                    Telephone Number
                                                                                                                                             (___ ___ ___) ___ ___ ___-___ ___ ___ ___
                                        Institution Signature and Title of Bank or Financial Institution Official Bank Official’s Typed or Printed Name
                  Bank or Financial 

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                                                                                                              Embosser or black ink rubber stamp seal Subscribed and sworn before me, this
                                                                                                                                                                              day of                                            year
                                                                                                                                                      State                    County (or City of St. Louis)     My Commission Expires

                                                                                                                                                      Notary Public Signature                     
                                                                                    Notary Public
                                                                                                                                                      Notary Public Name (Typed or Printed)

                                                                                                             The following Authorization for Release of Confidential Information has been set forth at the request of the Missouri Department 
                                                                                                             of Revenue and does not constitute a part of, or an exhibit to, the Irrevocable Letter of Credit on the reverse side of this form.

                                                                                                              I hereby authorize release of confidential tax information to ______________________________________________________
                                                                                                                                                                                                 (Bank or Financial Institution)
                                                                                                              for the purpose of making demand for payment on Irrevocable Letter of Credit Number ________________________________

                                                                                                              as long as the obligation remains in force and effect. Release of this information to the named banking institution does not give the 
                                                                                                              banking institution authority to request information other than information concerning the delinquent periods for which a demand for 
                                                                                                 Information  payment is being made.  I also release the Director of Revenue and Department of Revenue personnel from any 
                                                                                                              and all liability pursuant to any disclosure of confidential tax information that is necessary for making demand for or receiving such 
                                                                                                              payment.  By signing this Authorization, I state that I have the legal authority to bind the taxpayer or business below.
                                                                                                              In witness whereof, this taxpayer or business duly executed the foregoing this ______ day of  _________________, 20 ______.
                                          Authorization for Release of Confidential 

                                                                                                             Signature of Owner, Partner, Corporate Officer, or Member        Typed or Printed Name of Person Signing this Release

                                                                                                             Title                                                            Date (MM/DD/YYYY)
                                                                                    Signature
                                                                                                                                                                              ___ ___ / ___ ___ / ___ ___ ___ ___
                                                                                                                                                                                                                                Form 2879 (Revised 01-2024)

Mail to:
Sales and Use or Transient Employer 
Withholding Tax                                                                                                          Motor Fuel Tax                                        Cigarette Tax                     Other Tobacco Products 
Taxation Division                                                                                                        Taxation Division                                     Taxation Division                 Taxation Division
P.O. Box 357                                                                                                             P.O. Box 300                                          P.O. Box 811                      P.O. Box 3320
Jefferson City, MO  65105-0357                                                                                           Jefferson City MO 65105-0300                          Jefferson City MO 65105-0811      Jefferson City, MO 65105-3320
Phone:  (573) 751-5860                                                                                                   Phone:  (573) 751-2611                                Phone:  (573) 751-7163            Phone:  (573) 751-5772
Fax:  (573) 522-1722                                                                                                     Fax: (573) 522-1720                                   Fax:  (573) 522-1720              Fax:  (573) 522-1720
E-mail:  businesstaxregister@dor.mo.gov                                                                                  E-mail:  excise@dor.mo.gov                            E-mail:  DOR.tobacco@dor.mo.gov   E-mail:  DOR.tobacco@dor.mo.gov

                                                                                                                   Visit dor.mo.gov for additional information.  TTY (800) 735-2966

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