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Department Use Only
Form (MM/DD/YY)
Request for Tax Clearance for Transient Employers
943T
Missouri Tax I.D. Federal Employer
Number I.D. Number
Charter Reporting Period
Number (MM/YY)
Home State of Incorporation Begin Date Doing Missouri Business or
Certificate of Authority in Missouri ___ ___ /___ ___ ___ / ___ ___ ___
1. Does this business have Missouri resident employees for which they are required to withhold Missouri taxes? Yes No
2. Does the business have non-resident employees working in Missouri? Yes No
3. Do you pay contributions to the Division of Employment Security? Yes No If yes, what is the account number? _______________
Note: If there has been a change in the ownership of your business, contact the Taxation Division at the telephone number below to
ensure your account is properly registered prior to requesting a Tax Clearance.
Type Corporation Partnership Sole Proprietorship Limited Liability Company — Taxed as (select one)
Ownership Corporation Sole Owner Partnership
Name of Business or Corporation Doing Business As (DBA)
Business Mailing Address City State ZIP Code
Contact Person Phone Number Contact Person E-mail Address
Mailing Address
(___ ___ ___)___ ___ ___-___ ___ ___ ___
If there has been a name change for this corporation, please provide the prior name. ______________________________________
This corporation files consolidated corporation income tax returns in Missouri.
a. Parent corporation’s FEIN that returns are filed under b. Missouri Tax Identification Number of the parent corporation
Federal Tax Identification Number (FEIN) Missouri Tax Identification Number
Corporations | | | | | | | | | | | | | |
Missouri corporation franchise tax returns cannot be filed consolidated and must be filed by each corporation.
Your Social Security Number Spouse’s Social Security Number
| | | | | | | | | | | | | | | |
Sole If individual income tax returns have previously been filed in another state, please provide a list of the states and years filed.
Proprietorships ___________________________________________________________________________________________________
Authorization for Release of Confidential Information: 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
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Authorization for Release Address City State ZIP Code
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Signature of Owner or Officer Printed Name
Signature Title Telephone Number Date (MM/DD/YYYY)
(___ ___ ___)___ ___ ___-___ ___ ___ ___ ___ ___ /___ ___ ___ / ___ ___ ___
Form 943T (Revised 09-2014)
Mail to: Taxation Division Phone: (573) 751-0459
P.O. Box 357 Fax: (573) 522-1722
Jefferson City, MO 65105-0357 E-mail: businesstaxregister@dor.mo.gov *14604010001*
Visit http://dor.mo.gov/business/register/ for additional information. 14604010001