City of Kansas City, Missouri - Revenue Division
RD-111
                             EXTENSION - PROFITS RETURN
2021
                             EARNINGS TAX

                             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. Estimated taxable earnings (or net profits)                                   1                                           .
2. Tax Due    (1% of Line 1)                                                     2                                           .
3. Amount Paid    (should be the same as Line 2)                                 3                                           .
NOTES:
An extension is granted for a period of six (6) months.  This is not an extension of time for payment of taxes.  This is a request for additional
time to file your return.  An automatic extension of time to file will be granted upon the timely receipt of tax due (Line 3) and a completed
application for extension.  If the extension of time is not granted, you will receive a denial notice.

Extension payment must be 90% of the tax due to avoid penalty and interest.

General Instructions:
WHO MAY FILE THIS EXTENSION

       •   Every resident individual who derives income from an unincorporated business, association, profession, or other business 
           activity.

       •   Every nonresident individual who derives income from an unincorporated business, association, profession or other 
           activity doing business within Kansas City, Missouri.

       •   Every corporation or partnership conducting a business within the city or rendering or performing services within Kansas 
           City, Missouri.

       •   If your extension -- (Wage Earner Return Earnings Tax) earnings are derived solely from salaries, wages, commissions, or 
           other compensations you should complete Form RD-112.

       •   The due date  or extension payment is f April 1 th 8 for calendar year tax filers or 105 days after the end of the fiscal year if 
           not a calendar year filer. 

DO NOT SEND CASH. Make check payable to: KCMO City Treasurer
Mail to: City of Kansas City, Missouri, Revenue Division, PO Box 843825 Kansas City, MO 64184-3825
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