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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 Sales or Use Tax Cash Bond Refund
0 0 0 7 7 7 7 0 472
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.
1 1 1 1 1 1 1 1 Number
1 1 1 2 2 2 2 1
Business Name Amount of Bond Filed (Dollars)
1 1 1 3 3 3 3 1
1 1 1 4 4 4 4 1 $
1 1 1 5 5 5 5 1 Business Address
1 1 1 6 6 6 6 1
1 1 1 7 7 7 7 1 CurrentInformation CityBond State Zip Code
1 1 1 8 8 8 8 1
1 1 1 9 9 9 9 1
2 2 2 0 0 0 0 2
2 2 2 1 1 1 1 2 Cash Bond has been filed for the required period (two consecutive years) with a satisfactory tax compliance
2 2 2 2 2 2 2 2
2 2 2 3 3 3 3 2 Sold or quit business on (MM/DD/YYYY) ___ ___ /___ ___ /___ ___ ___ ___
2 2 2 4 4 4 4 2 Business never opened
2 2 2 5 5 5 5 2
2 2 2 6 6 6 6 2 Other (Explain)
2 2 2 7 7 7 7 2 ReasonReturnforRequestBond
2 2 2 8 8 8 8 2
2 2 2 9 9 9 9 2
3 3 3 0 0 0 0 3
3 3 3 1 1 1 1 3 Name (Check will be issued in the name of the owner(s) listed on the Department’s records) Telephone Number (Daytime)
3 3 3 2 2 2 2 3 (___ ___ ___) ___ ___ ___-___ ___ ___ ___
3 3 3 3 3 3 3 3
Address
3 3 3 4 4 4 4 3
3 3 3 5 5 5 5 3
3 3 3 6 6 6 6 3 MailCityRefund To State Zip Code
3 3 3 7 7 7 7 3
3 3 3 8 8 8 8 3
3 3 3 9 9 9 9 3 Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
4 4 4 0 0 0 0 4 I also swear and affirm all returns have been filed and paid and there are no outstanding liabilities.
4 4 4 1 1 1 1 4 Signature of Taxpayer Title
4 4 4 2 2 2 2 4
4 4 4 3 3 3 3 4 Signature
E-mail Address Date (MM/DD/YYYY)
4 4 4 4 4 4 4 4
4 4 4 5 5 5 5 4 ___ ___ /___ ___ /___ ___ ___ ___
4 4 4 6 6 6 6 4
4 4 4 7 7 7 7 4
1. $
4 4 4 8 8 8 8 4
4 4 4 9 9 9 9 4
2. $
4 4 4 0 0 0 0 4 Cash Bond
5 5 5 1 1 1 1 5 3. $
5 5 5 2 2 2 2 5
5 5 5 3 3 3 3 5 Total Amount Refunded $
5 5 5 4 4 4 4 5 DepartmentCheck AmountUse Only Check Date (MM/DD/YYYY) Refund Check Number
5 5 5 5 5 5 5 5
___ ___ /___ ___ /___ ___ ___ ___
5 5 5 6 6 6 6 5 Form 472 (Revised 12-2014)
5 5 5 7 7 7 7 5
5 5 5 8 8 8 8 5 Mail to: Taxation Division Phone:(573) 751-5860
Visit http://dor.mo.gov/business/register/
P.O. Box 357
5 5 5 9 9 9 9 5 TTY: (800) 735-2966
for additional information.
Jefferson City, MO 65105-0357 Fax: (573) 522-1722
5 5 5 0 0 0 0 5 E-mail: businesstaxregister@dor.mo.gov
6 6 6 1 1 1 1 6
6 6 6 2 2 2 2 6 *14603010001*
6 6 6 3 3 3 3 6 14603010001
6 6 6 4 4 4 4 6
6 6 6 5 5 5 5 6
6 6 666 6 6 6
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