City of Kansas City, Missouri - Revenue Division
   RD-107
   2019                             CONVENTION & TOURISM TAX
                                    FOOD ESTABLISHMENT

                                    Phone: (816) 513-1120
                                    E-file:  kcmo.gov/quicktax

Legal Name:                                                             Mailing Address:
DBA Name:
FEIN or SSN:                                                            Business Address:
Account ID:

Period From:                           Period To:
                                                                                                                   DOLLARS    CENTS
1. Food Sales    (excluding liquor)                                                        1  $                            .
2. Liquor Sales                                                                            2  $                            .
3. Total Gross Receipts    (Line 1 plus Line 2)                                            3  $                            .
4a. Increase in gross receipts - Other
                                                                 4a     $                 .
4b. Increase in gross receipts - Other                           4b     $                 .

4c. Total increase    (Sum of Line 4a and 4b)                                              4c $                            .
4d. Decrease in gross receipts - Tax Exempt Organizations        4d     $                 .
4e. Decrease in gross receipts - Other                           4e     $                 .

4f. Total decrease    (Sum of Line 4d and 4e)                                              4f $                            .
5. Taxable Sales    (Sum of Line 3 and 4c minus Line 4f)                                   5  $                            .
6. Tax Due    (Line 5 times 2%)                                                            6  $                            .

7. 2% Timely    (Line 6 times 2%, only if paid before due date)                            7  $                            .
8. Total Tax Due    (Line 6 minus Line 7)                                                  8  $                            .
                                                (5% per month of the outstanding tax due) 
9a. Penalty: "Failure to file return timely"    (maximum penalty 25%)                      9a $                            .
9b. Penalty: "Failure to pay amount due"         (5% of tax due)                           9b $                            .
10. Interest (5% per annum until tax is paid)                                              10 $                            .

11. Previous credit or prior payment                                                       11 $                            .
12. Total Amount Due    (Sum of Lines 8, 9a, 9b, 10 minus Line 11)                         12 $                            .
13. Amount Paid                                                                            13 $                            .
14. "X" Box if Amended return                                                              14
   If no longer conducting business in Kansas City, MO enter date closed
15. DO NOT COMPLETE IF BUSINESS IS STILL OPERATING                                         15                         /       /
                                                                                                                   MM      DD   YY
DO NOT SEND CASH. Make check payable to: KCMO City Treasurer
Mail to: City of Kansas City, Missouri, Revenue Division, PO Box 804107 Kansas City, MO 64180-4107
For changes to name, address or FEIN/SSN, please contact us at revenue@kcmo.org or (816) 513-1120.
I authorize the Commissioner of Revenue or delegate to discuss my return and attachments with my preparer.         Yes        No
Under penalties of perjury, I declare this return to be true, correct, and complete accounting for the taxable year
stated.

Print Name of Taxpayer                 Signature                        Title                     Date                Phone

Preparer Name (if other than taxpayer) Signature                        Title                     Date                Phone

                                            City of Kansas City, Missouri - Revenue Division
RD-107
2019                                        CONVENTION & TOURISM TAX
                                            FOOD ESTABLISHMENT

                                            Phone: (816) 513-1120
                                            E-file:   kcmo.gov/quicktax

                                            INSTRUCTIONS FOR COMPLETING FORM RD-107
Line 1.     Enter total gross receipts - Food Sales.
Line 2.     Enter total gross receipts - Liquor Sales.
Line 3.     Enter gross receipts (Line 1 plus Line 2).
Line 4a.   Enter amount increasing gross receipts and description.
Line 4b.   Enter amount increasing gross receipts and description.
Line 4c.   Enter the sum of Lines 4a and 4b.
Line 4d.   Enter decrease to gross receipts from tax exempt organizations.
                  Exempt Organizations - Agencies of government, qualifying organizations, and qualifying persons under RSMo
                  144.010 through 144.510 are applicable as long as exemption certificates required by RSMo 144.010 are maintained on
                  file.
Line 4e.   Enter amount decreasing gross receipts and description. 
Line 4f.    Enter the sum of Lines 4d and 4e.
Line 5.     Enter taxable sales (Sum of Lines 3 and 4c minus Line 4f).
Line 6.     Enter tax due (Line 5 times 2%).
Line 7.     If return is filed and paid prior to due date, enter discount amount (Line 6 times 2%).
                   Return Due Date:
                       a)  For periods ending on a quarter-end (i.e. March 31st, June 30th, September 30th, December 31st), Form RD-107 is
                            due on or before the last day of the next month.
                            (Example 1: For the period from January 1st to March 31st, Form RD-107 is due by April 30)
                            (Example 2: For the period from March 1st to March 31st, Form RD-107 is due by April 30)
                       b)  For periods not ending on a quarter-end, Form RD-107 is due on or before the 20th day of the next month.
                            (Example 1: For the period from January 1st to January 31st, Form RD-107 is due by February 20th)
Line 8.     Enter total tax due (Line 6 minus Line 7).
Line 9a.   For failure to file return timely enter penalty of 5% of Line 6 per month (maximum penalty 25%).
Line 9b.   For failure to pay amount due enter amount of penalty due (Line 6 times 5%).
Line 10.   If return is delinquent, enter amount of interest due. Statutory prime interest rate based on RSMo Section 32.065. 
Line 11.   Enter amount of credit or prior payment(s).
Line 12.   Enter amount due (Sum of Lines 8, 9a, 9b and 10 minus Line 11).
Line 13.   Enter amount paid.
Line 14.   Enter "X" if this amends a previously submitted return for the same period. 
Line 15.   If this is a final return under this ownership, enter date business closed and/or no longer conducting business in Kansas City,
               Missouri.

                                            MAKE CHECK PAYABLE TO: KCMO City Treasurer 
               MAIL TO: City of Kansas City, Missouri, Revenue Division, PO Box 804107 Kansas City, MO 64180-4107

                                            (Retain copies for liquor license renewal, if applicable)

                       Visit our website at kcmo.gov/kctax for more forms, instructions and the Convention and Tourism Regulations.