Department Use Only
                                                              Form                                                                                                     (MM/DD/YY)
                                                              5522     No Tax Due Request
                                                                                                                                                                                                                   Reset Form            Print Form

                                                                                                                                     **DO NOT enter hyphens or dashes**
                                                               Missouri Tax Identification Number                                    Federal Employer Identification Number (FEIN)                                 Social Security Number
                                                                      |        |        |        |        |        |        |              |        |        |        |        |        |        |        |              |        |        |        |        |        |        |        |        
                                                              Name of Business                                                                     Doing Business As Name (DBA)

                          Business
                                                              Business Mailing Address                                                             City                      State                                 ZIP Code
                                                                                                                                                                                                                                         _

                                                                       I am required to provide a No Tax Due Certificate for the following reason:

                                                               Business License                   Egg License                                      Liquor License            Fireworks License                                Frozen Dessert   
                                                                *Indicate below which city or 
                                                                county the request is needed.

                                                               Kennel License                     Lodging License                                  Pharmacy                  Picnic License

                                                              *City                                                                                                    County
                                  Reason For Request
                                                                                                                                                         OR

                                                              If you need a No Tax Due certificate for any other reason, you can contact the Tax clearance Unit at 573-751-9268. 
                                                              If you need a Full Tax Clearance, please fill out a Request for Tax Clearance (Form 943).

                                                               All correspondence will be released to the person authorized below.  Release of this information to a third party (such as an accountant) at the request of the taxpayer 
                                                               does not give the third party authority to request further information from the Department. To obtain additional information or to represent the taxpayer before the 
                                                               Department, the taxpayer must execute a Power of Attorney designating the third party as its representative.
                                                               Name of Person Authorized to Receive This Information                               Title                                                            Phone Number
                                                                                                                                                                                                                    ( _ _ _ ) _ _ _ - _ _ _ _
                                                               Address                                                                             City                                                            State      ZIP Code 
             Authorization
                                                               E-mail Address of Authorized Person 

                                                              Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. 
                                                               Signature of Owner or Officer                                                       Title                                                            Phone Number
                                                                                                                                                                                                                    ( _ _ _ ) _ _ _ - _ _ _ _
                                                    Signature  Printed Name of Owner or Officer                                                    Please email results to:                                          

                                                                                                                                                                                                                                         Form 5522 (Revised 12-2021)
Mail to:   Taxation Division                                                                                                         E-mail:  taxclearance@dor.mo.gov
                                                                 P.O. Box 3666                                                       Visit dor.mo.gov/faq/taxation/business/tax-clearance.html for additional information.
                                                                 Jefferson City, MO 65105-3666
                                                                                                                                     Ever served on active duty in the United States Armed Forces?  
 Phone:                                                             (573) 751-9268                                                   If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible 
                                                    Fax:            (573) 522-1265                                                   military individuals. A list of all state agency resources and benefits can be found at 
                                                    TTY:   (800) 735-2966                                                            veteranbenefits.mo.gov/state-benefits/.