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 Request for Tax Clearance for Transient Employers
0 0 0 7 7 7 7 0 943T
0 0 0 8 8 8 8 0
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 Charter Reporting Period
1 1 1 4 4 4 4 1 Number (MM/YY)
1 1 1 5 5 5 5 1 Home State of Incorporation Begin Date Doing Missouri Business or
1 1 1 6 6 6 6 1 Certificate of Authority in Missouri ___ ___ /___ ___ ___ /___ ___ ___
1 1 1 7 7 7 7 1
1 1 1 8 8 8 8 1 1. Does this business have Missouri resident employees for which they are required to withhold Missouri taxes? Yes No
1 1 1 9 9 9 9 1 2. Does the business have non-resident employees working in Missouri? Yes No
2 2 2 0 0 0 0 2 3. Do you pay contributions to the Division of Employment Security? Yes No If yes, what is the account number? _______________
2 2 2 1 1 1 1 2 Note: If there has been a change in the ownership of your business, contact the Taxation Division at the telephone number below to
2 2 2 2 2 2 2 2 ensure your account is properly registered prior to requesting a Tax Clearance.
2 2 2 3 3 3 3 2 Type Corporation Partnership Sole Proprietorship Limited Liability Company — Taxed as (select one)
2 2 2 4 4 4 4 2 Ownership Corporation Sole Owner Partnership
2 2 2 5 5 5 5 2
2 2 2 6 6 6 6 2 Name of Business or Corporation Doing Business As (DBA)
2 2 2 7 7 7 7 2
2 2 2 8 8 8 8 2 Business Mailing Address City State ZIP Code
2 2 2 9 9 9 9 2
3 3 3 0 0 0 0 3 Contact Person Phone Number Contact Person E-mail Address
Mailing Address
(
3 3 3 1 1 1 1 3 ___ ___ ___)___ ___ ___-___ ___ ___ ___
3 3 3 2 2 2 2 3
3 3 3 3 3 3 3 3 If there has been a name change for this corporation, please provide the prior name. ______________________________________
3 3 3 4 4 4 4 3
This corporation files consolidated corporation income tax returns in Missouri.
3 3 3 5 5 5 5 3
a. Parent corporation’s FEIN that returns are filed under b. Missouri Tax Identification Number of the parent corporation
3 3 3 6 6 6 6 3
3 3 3 7 7 7 7 3 Federal Tax Identification Number (FEIN) Missouri Tax Identification Number
3 3 3 8 8 8 8 3 Corporations | | | | | | | | | | | | | |
3 3 3 9 9 9 9 3 Missouri corporation franchise tax returns cannot be filed consolidated and must be filed by each corporation.
4 4 4 0 0 0 0 4
4 4 4 1 1 1 1 4 Your Social Security Number Spouse’s Social Security Number
4 4 4 2 2 2 2 4 | | | | | | | | | | | | | | | |
4 4 4 3 3 3 3 4 Sole If individual income tax returns have previously been filed in another state, please provide a list of the states and years filed.
4 4 4 4 4 4 4 4
___________________________________________________________________________________________________
4 4 4 5 5 5 5 4 Proprietorships
4 4 4 6 6 6 6 4 Authorization for Release of Confidential Information: All correspondence will be released to the person authorized below. Release of
4 4 4 7 7 7 7 4 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
4 4 4 8 8 8 8 4 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.
4 4 4 9 9 9 9 4
Name of Person Authorized to Receive This Information Title Phone Number
4 4 4 0 0 0 0 4
5 5 5 1 1 1 1 5 for Release (___ ___ ___)___ ___ ___-___ ___ ___ ___
5 5 5 2 2 2 2 5 Authorization Address City State ZIP Code
5 5 5 3 3 3 3 5
5 5 5 4 4 4 4 5
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
5 5 5 5 5 5 5 5
5 5 5 6 6 6 6 5 Signature of Owner or Officer Printed Name
5 5 5 7 7 7 7 5
5 5 5 8 8 8 8 5 Signature Title Telephone Number Date (MM/DD/YYYY)
5 5 5 9 9 9 9 5 (___ ___ ___)___ ___ ___-___ ___ ___ ___ ___ ___ /___ ___ ___ /___ ___ ___
Form 943T (Revised 09-2014)
5 5 5 0 0 0 0 5 Mail to: Taxation Division Phone:(573) 751-0459
6 6 6 1 1 1 1 6 P.O. Box 357 Fax: (573) 522-1722
6 6 6 2 2 2 2 6 Jefferson City, MO 65105-0357 E-mail: businesstaxregister@dor.mo.gov *14604010001*
6 6 6 3 3 3 3 6 Visit http://dor.mo.gov/business/register/ for additional information. 14604010001
6 6 6 4 4 4 4 6
6 6 6 5 5 5 5 6
6 6 666 6 6 6