Reset This Page Only Print Form
Department Use Only
Form (MM/DD/YY)
Use Tax Protest Payment Report
2041 Reporting Period
(MM/YY)
Missouri Tax I.D. Federal Employer
Number I.D. Number
Case Number
(if applicable)
PPRE
Type of Tax Protested r Consumer’s Use Tax r Vendor’s Use Tax FPRE
Owner’s Name Business Name
Mailing Address City State ZIP Code
Business
E-mail Address Phone Number
(__ __ __) __ __ __ - __ __ __ __
This form is to be used for filing a use tax protest payment in compliance with Section 144.700, RSMo.
Vendor’s Use Tax Tax Type Gross Receipts Adjustments Taxable Sales Tax Rate Amount of Tax
Business Location (Enter below) State Use - 3%
Conservation - 1/8%
Education - 1%
Parks and Soil - 1/10%
-
-
-
Reset This Section Only -
-
Vendor’s Use Totals Enter total amount of vendor’s use tax from all pages 1.
Subtract 2% timely payment 2.
allowance (If applicable) –
Vendor’s use tax due 3.
(Line 1 minus Line 2) =
Consumer’s Use Tax Tax Type Taxable Purchases Tax Rate Amount of Tax
Business Location (Enter below) State Use 3%
Conservation 1/8%
Education 1%
Parks and Soil 1/10%
Protested Amount(s)
Reset This Section Only
Consumer’s Use Totals Enter total amount of consumer’s use tax from all pages 4.
Total use tax due: 5.
(add Lines 3 and 4)............................. =
Final Return: If this is your final return, enter the close date below and select the reason Add: Interest for late payment 6.
for closing your account. Missouri law requires any person selling or discontinuing (see instructions) ................................ +
business to make a final use tax return within 15 days of the purchase or closing. Add: Additions to tax (5% per month 7.
late of Line 5, maximum 25%) ........... +
Date Business Closed (MM/DD/YYYY) __ __ /__ __ /__ __ __ __ Subtract: Approved credit 8.
(attach credit memorandum) .............. –
r Out of Business r Sold Business r Leased Business Remit single check 9.
for this amount: ................................... =
*14019010001*
14019010001 Form 2041 (Revised 02-2020)