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0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80
1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 51
0 0 0 4 4 4 4 0 Department Use Only
0 0 0 5 5 5 5 0 Form (MM/DD/YY)
0 0 0 6 6 6 6 0 Cash Bond
0 0 0 7 7 7 7 0 332
0 0 0 8 8 8 8 0
0 0 0 9 9 9 9 0
Missouri Tax I.D.
1 1 1 0 0 0 0 1 Number Federal Employer
1 1 1 1 1 1 1 1 (Optional) I.D. Number
1 1 1 2 2 2 2 1
1 1 1 3 3 3 3 1 Personal or company checks will not be accepted as payment. Please remit a cashier’s check or money order.
1 1 1 4 4 4 4 1 Select only one:
1 1 1 5 5 5 5 1
1 1 1 6 6 6 6 1 r Sales and Use Tax (If required by The Department of Revenue) r Motor Fuel Tax
1 1 1 7 7 7 7 1 r Other Tobacco Products Motor Fuel license type (Select One):
1 1 1 8 8 8 8 1
1 1 1 9 9 9 9 1 r Cigarette Tax r Supplier or Permissive Supplier r Distributor
2 2 2 0 0 0 0 2 Cashr BondTransientTypeEmployer Withholding and Unemployment Tax r Terminal Operator r Transporter
2 2 2 1 1 1 1 2
2 2 2 2 2 2 2 2 Amount (U.S. Currency - No personal or company checks) Date (MM/DD/YYYY)
2 2 2 3 3 3 3 2
2 2 2 4 4 4 4 2 $ __ __ / __ __ / __ __ __ __
At the request of Taxpayers or Business (Owner’s name, all Partners, Corporation, or LLC Name)
2 2 2 5 5 5 5 2
2 2 2 6 6 6 6 2
2 2 2 7 7 7 7 2 Taxpayer or Business Owner’s Address City
2 2 2 8 8 8 8 2
2 2 2 9 9 9 9 2 County State ZIP Code E-mail Address
3 3 3 0 0 0 0 3
3 3 3 1 1 1 1 3
3 3 3 2 2 2 2 3 ________________________________________________________________(Taxpayer) hereby files with the
3 3 3 3 3 3 3 3 Missouri Department of Revenue this cash bond and the attached cashier’s check or money order in the amount of
3 3 3 4 4 4 4 3 ___________________________________________________________________ ($___________________________).
3 3 3 5 5 5 5 3 Taxpayer understands that it is required to comply with all the provisions of any statutorily or constitutionally authorized state
3 3 3 6 6 6 6 3 or local tax.
3 3 3 7 7 7 7 3
3 3 3 8 8 8 8 3 If Taxpayer becomes delinquent and owes the Department the above indicated tax, related fees, interest, additions to tax,
3 3 3 9 9 9 9 3 and penalties due the state of Missouri, the Director of Revenue may forfeit this bond and apply it to any unpaid
4 4 4 0 0 0 0 4 delinquencies.
4 4 4 1 1 1 1 4
4 4 4 2 2 2 2 4 Delivery of any demands, notice, or service of process by the Department shall be deemed sufficient and made in the
4 4 4 3 3 3 3 4 state of Missouri if personally served or if mailed by U.S. mail to the taxpayer or business address as set forth above.
4 4 4 4 4 4 4 4 This cash bond and any legal action pertaining thereto shall be governed by and construed in accordance with the laws of
4 4 4 5 5 5 5 4 the state of Missouri. The parties understand and agree that the exclusive jurisdiction for any action concerning this bond
4 4 4 6 6 6 6 4 shall be the state of Missouri and the only venue shall be in the Circuit Court of Cole County, Missouri.
4 4 4 7 7 7 7 4
4 4 4 8 8 8 8 4 By signing this cash bond, the undersigned states that he or she has authority to bind the taxpayer or business identified
4 4 4 9 9 9 9 4 herein.
4 4 4 0 0 0 0 4 Owner, Partner, Corporate Officer or LLC Member Date (MM/DD/YYYY)
5 5 5 1 1 1 1 5 Sign
5 5 5 2 2 2 2 5 __ __ / __ __ / __ __ __ __
5 5 5 3 3 3 3 5 Form 332 (Revised 04-2021)
Mail to:
5 5 5 4 4 4 4 5
Sales and Use or Transient Employer
5 5 5 5 5 5 5 5 Withholding Motor Fuel Tax Cigarette Tax Other Tobacco Products
5 5 5 6 6 6 6 5 Taxation Division Taxation Division Taxation Division Taxation Division
5 5 5 7 7 7 7 5 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
5 5 5 8 8 8 8 5 Phone: (573) 751-5860 Phone: (573) 751-2611 Phone: (573) 751-7163 Phone: (573) 751-5772
5 5 5 9 9 9 9 5 Fax: (573) 522-1722 Fax: (573) 522-1720 Fax: (573) 522-1720 Fax: (573) 522-1720
5 5 5 0 0 0 0 5 E-mail: businesstaxregister@dor.mo.gov E-mail: excise@dor.mo.gov E-mail: excise@dor.mo.gov E-mail: excise@dor.mo.gov
6 6 6 1 1 1 1 6 Visit http://dor.mo.gov/business/register/ for additional information. TTY (800) 735-2966
6 6 6 2 2 2 2 6
6 6 6 3 3 3 3 6 *14602010001*
6 6 6 4 4 4 4 6 14602010001
6 6 6 5 5 5 5 6
6 6 666 6 6 6
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