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                                                                                                              Form                 2023 Partnership or S Corporation Withholding 
                                                                                                                                   Exemption or Revocation Agreement                                             *23329010001*
                                                                    MO-3NR
                                                                                                                                                                                                                                                   23329010001

For calendar year Jan. 1 - Dec. 31, 2023, or fiscal year beginning ___________, _____ and ending ___________, _____.

                                                                                                                            r Revocation Indicator                                    Department Use Only       
                                                                                                                                                                                                                                                       |      |      |      |      |      |      |

                                                                                                                                                                          Federal Employer Identification Number                                 Missouri Tax Identification Number
                                                                                                                                 r Partnership      r S Corporation
                                                                                                                                                                               |        |        |        |        |        |        |        |        |        |        |        |        |        |        |
                                                                                                                            Business Name                                                  Street Address
                                                                                                       Address
                                                                                                                            City                                    State         ZIP Code E-mail Address
                                                  Part 1 - Name and 

                                                                                                                            Taxpayer Name                                                                                                       Social Security Number 
                                                                                                                                                                                                                                                     |        |        |        |        |        |        |        |
                                                                                                                            Street Address                                City                                   State                               ZIP Code

                                                                                                                            I, _______________________________________, as a partner or shareholder of the above named partnership or S corporation, 
                                                                                                                            request to be exempt from Missouri income tax withholding on my Missouri distributive share item(s) received through this partnership 
                                                                                                                            or S corporation for the tax year 2023, and all subsequent tax years, until I notify the Department of a change in this election. By signing 
                                                                                                                            this agreement, I agree to:
                                                                                                                            1)   File an individual income tax return in accordance with the provisions of Section 143.481, RSMo, and make timely payment 
                                                                                                                             of all taxes imposed on me by this state with respect to the income of the partnership or S corporation for every year in which 
                                                                    Part 2 - Withholding Tax Exemption                       I maintain my exemption status; and
                                                                                                                            2)   Be subject to personal jurisdiction in this state for the purpose of the collection of income taxes, together with related interest 
                                                                                                                             and penalties, imposed on me by this state with respect to my distributive share of the income for this partnership or S corporation.
                                                                                                                            Taxpayer Name                                                                              Social Security Number 
                                                                                                                                                                                                                            |        |        |        |        |        |        |        |
                                                                                                                            Street Address                                City                                   State                               ZIP Code

                                                                                                                            I, _______________________________________, as a partner or shareholder of the above named partnership or S 
                                                                                                                            corporation,  do  hereby  revoke  my  previous  withholding  election  dated  ___  ___  /  ___  ___  /  ___  ___  ___  ___.  At  this 
                                                                                                                            time, I request to be subject to withholding by this partnership or S corporation on my Missouri distributive share item(s) 
                         Part 3 - Withholding Tax                                                      Exemption Revocation received through this partnership or S corporation for the tax year 2023, and all subsequent tax years, until I notify the 
                                                                                                                            Department of a change in this election.

                                                                                                                            Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
                                                                                                                            Signature of Taxpayer                                          Printed Name

                                                                                                                            Daytime Telephone                       Date (MM/DD/YYYY)                                  Department Use Only
                                                                    Part(___4 -___Signature___) ___ ___ ___-___ ___ ___ ___      ___ ___ / ___ ___ / ___ ___ ___ ___

Mail to:   Taxation Division                                                                                                                                                                                                                                           Form MO-3NR (Revised 12-2023)
                                                                                                                                                                    E-mail:  income@dor.mo.gov 
                                                                                                                               P.O. Box 3815 
                                                                                                                               Jefferson City, MO 65105-3815        Visit dor.mo.gov/taxation/business/tax-types/partnership/ or additional information.
                                                                                                                              
 Phone:                                                                                                                          (573) 751-1467                     Ever served on active duty in the United States Armed Forces?  
                                                                    Fax:                                                         (573) 526-7939                     If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible 
                                                                    TTY:   (800) 735-2966                                                                           military individuals. A list of all state agency resources and benefits can be found at 
                                                                                                                                                                    veteranbenefits.mo.gov/state-benefits/.

                                          Form MO-3NR Instructions 
Partnership or S Corporation Withholding Exemption or Revocation Agreement

The Form MO-3NR is used to initiate an agreement between                                       Part 3 
the nonresident partner or S corporation shareholder and the                Withholding Tax Exemption Revocation 
Missouri Department of Revenue (Department) for an election of 
exempt status from Missouri income tax withholding on Missouri        (Completed by the taxpayer electing to revoke the 
distributive share item(s) of partnership or S corporation income.                       exempt status)
Additionally, the Form MO-3NR can be used to revoke a previous 
                                                                      Enter  your name, social security number, and address in the 
election of exempt withholding status.
                                                                      spaces provided. By revoking your exemption status, the 
Note:  If you are electing to revoke your withholding exemption       partnership or S corporation is required to withhold Missouri 
status, please check the box at the top of the form and complete      income taxes on your Missouri distributive share item(s) and 
Parts 1, 3, and 4 only.                                               to remit this withholding tax on your behalf. The revocation will 
                                                                      remain in effect until you elect to change your exempt status by 
                        Part 1                                        filing a new Form MO-3NR.
                Name and Address 
                                                                                               Part 4 
(Completed by the partnership or S corporation)
                                                                                         Signature
Select partnership or S corporation in the spaces provided, enter 
the partnership or S corporation’s federal identification number,     You  must sign and date  your  agreement.  Please  include a 
Missouri identification number (if applicable), name, address and     daytime telephone number where you may be reached in case 
e-mail address.                                                       the Department has questions regarding your agreement.

                        Part 2                                                           When to File
                Withholding Tax Exemption                             This agreement will be considered timely filed for a taxable year,  
(Completed by the taxpayer electing exemption from                    and for all subsequent taxable years, if it is filed at or before the 
                        withholding)                                  time the annual return for such taxable year is required to be 
                                                                      filed.
Enter  your name, social security number, and address in the 
spaces provided. By requesting an exemption from Missouri                                Where to File
withholding on your Missouri distributive share item(s) you are 
also agreeing to the following:                                       Mail the completed Form MO-3NR(s) to the address at the 
                                                                      bottom of the form.
(1)   To  file  a  return  in  accordance  with  the  provisions  of  
Section 143.481, RSMo, and to make timely payment 
of all taxes imposed on you by the state of Missouri 
with  respect  to  the  income  of  the  partnership  or  S 
corporation until you notify the Department of a change 
in this elec tion; and
(2)   To be subject to personal jurisdiction in this state for 
the purpose of the collection of income taxes, together 
with related interest and penalties, imposed on you by 
this state with respect to your distributive share of the 
income of this partnership or S corporation.

                                      *23000000001*
                                            23000000001                                                Form MO-3NR (Revised 12-2023)