0 0 0 1 1 1 1 0
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
Missouri Department of Revenue (MM/DD/YY)
0 0 0 6 6 6 6 0 Sales Tax Protest Payment Affidavit
0 0 0 7 7 7 7 0 163
Reporting Period
0 0 0 8 8 8 8 0 (MM/YY)
0 0 0 9 9 9 9 0
1 1 1 0 0 0 0 1 Missouri Tax I.D. Federal Employer
1 1 1 1 1 1 1 1 Number I.D. Number
1 1 1 2 2 2 2 1
1 1 1 3 3 3 3 1 Case Number
1 1 1 4 4 4 4 1 (if applicable)
1 1 1 5 5 5 5 1
1 1 1 6 6 6 6 1 Owner’s Name Business Name
1 1 1 7 7 7 7 1
1 1 1 8 8 8 8 1 Mailing Address City
1 1 1 9 9 9 9 1
2 2 2 0 0 0 0 2 Business State ZIP Code Phone Number PPRE
2 2 2 1 1 1 1 2 Department Use Only FPRE
(__ __ __) __ __ __ - __ __ __ __
2 2 2 2 2 2 2 2
2 2 2 3 3 3 3 2 This form is to be used for filing a sales tax protest payment in compliance with Section 144.700, RSMo. Use this form in conjunction with the
Nonprotested Sales Tax Payment Report (Form 2039) when filing a partial protest payment and use by itself when filing a fully protested payment.
2 2 2 4 4 4 4 2
2 2 2 5 5 5 5 2 Business Location Tax Type Gross Receipts Adjustments Taxable Sales Tax Amount of Tax
2 2 2 6 6 6 6 2 Indicate + or – ) Rate (%)
2 2 2 7 7 7 7 2 City: State 3%
2 2 2 8 8 8 8 2 Conservation 1/8%
2 2 2 9 9 9 9 2 Location Code: Education 1%
3 3 3 0 0 0 0 3 Parks and Soil 1/10%
3 3 3 1 1 1 1 3 City: __ __ __ __ __
3 3 3 2 2 2 2 3 County: __ __ __
3 3 3 3 3 3 3 3 Site: __ __ __ __
3 3 3 4 4 4 4 3
3 3 3 5 5 5 5 3
3 3 3 6 6 6 6 3
3 3 3 7 7 7 7 3
3 3 3 8 8 8 8 3
3 3 3 9 9 9 9 3
4 4 4 0 0 0 0 4
4 4 4 1 1 1 1 4
4 4 4 2 2 2 2 4
4 4 4 3 3 3 3 4 Enter total amount of tax from Schedule A (Page 3)
4 4 4 4 4 4 4 4 Protested Payment(s) 1.
Enter Total Amount Of Tax
4 4 4 5 5 5 5 4
4 4 4 6 6 6 6 4 Final Return: If this is your final return, enter the close date below and select Subtract: 2% of Line 1 2.
4 4 4 7 7 7 7 4 the reason for closing your account. The Sales Tax law requires any person only if paid by due date
–
4 4 4 8 8 8 8 4 selling or discontinuing business to make a final sales tax return within 15 days Total amount of tax due: 3.
4 4 4 9 9 9 9 4 of the sale or closing. (Line 1 minus Line 2)
=
4 4 4 0 0 0 0 4 Add: Interest for late payment 4.
5 5 5 1 1 1 1 5 Date Business Closed (MM/DD/YYYY) __ __ /__ __ /__ __ __ __
(See Instructions)
+
5 5 5 2 2 2 2 5 r Leased Business r Out of Business r Sold Business Add: Additions to Tax (5% per month 5.
5 5 5 3 3 3 3 5 late of Line 3, maximum 25%)
+
5 5 5 4 4 4 4 5 If you pay by check, you authorize the Department of Revenue to process Remit single check for this 6.
5 5 5 5 5 5 5 5 the check electronically.Any check returned unpaid may be presented amount: (Add Lines 3, 4, 5)
5 5 5 6 6 6 6 5 again electronically. =
5 5 5 7 7 7 7 5 Department Use Only
5 5 5 8 8 8 8 5
5 5 5 9 9 9 9 5
5 5 5 0 0 0 0 5
6 6 6 1 1 1 1 6
6 6 6 2 2 2 2 6 *14008010001*
6 6 6 3 3 3 3 6 14008010001 Form 163 (Revised 12-2014)
6 6 6 4 4 4 4 6
6 6 6 5 5 5 5 6
6 6 666 6 6 6