Form 2643A PDF Details

Form 2643A is an important document for businesses and individuals that engage in short-term or long-term transactions with foreign entities. The form helps to ensure that all tax obligations are met, and it's important to understand the requirements of this form before filing. This post will discuss the basics of Form 2643A, including what information is required and when it should be filed.

This page includes information about form 2643a. Our suggestion is that you read this information before you decide to start editing the PDF.

Question	Answer
Form Name	Form 2643A
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	mo dept of revenue form 2643a, mo form 2643, form 2643, missouri registration application form pdf

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Form

2643A

Missouri Tax I.D. Number (Optional)

Department Use Only (MM/DD/YY)

Missouri Tax Registration Application

Federal Employer

I.D. Number

Answer all questions completely. Incomplete and unsigned applications will delay processing.

Reason for Application

	3. Select all tax types for which you are applying:
	Sales from a Missouri business location
	Sales from a Missouri business location	Missouri Employer Withholding Tax
	r Retail Sales	r Regular Withholding
	r Temporary Retail Sales (Less than 191 days)	r Domestic or Household Employee
	r Retail Liquor or Alcohol Sales	r Transient Employer*
	Sales or Purchases from an out-of-state location	Corporate Tax
	r Vendor’s Use	r Corporate Income
	r Consumer’s Use (Missouri purchases	r Corporate Franchise
	where tax is not collected.)
	where tax is not collected.)	* Bond Required
		* Bond Required

Reason for Applying

rNew MO Registration

rPurchase of Existing Business

rReinstating Old Business

rConverted (must have converted through the Missouri Secretary of State’s office)

rCourt Appointed Receiver

rOther:

Information

4. Owner Name (Enter Corporation, LLC or Partnership Name, if applicable)

Address

E-mail Address

Owner

City

State

ZIP Code

County

If an individual is listed as the owner, you must also provide the following:

Social Security Number

Date of Birth (MM/DD/YYYY)

Telephone Number

___ ___ / ___ ___ / ___ ___ ___ ___

(___ ___ ___)___ ___ ___-___ ___ ___ ___

5. Ownership Type

r Sole Proprietor r Partnership r Government r Trust

All ownership types listed below, unless specifically exempted, are required to be registered with the Missouri Secretary of State’s Office (register

at sos.mo.gov or call (866) 223-6535). Your application will not be complete without providing the charter number issued to you by their office.

Type

r Limited Partnership - LP Number __________________________________

r Not Required to register with Missouri Secretary

r Limited Liability Partnership - LLP Number ___________________________

of State

Ownership

r Limited Liability Company - LLC Number ____________________________

r Other

Taxed as a r Disregarded Entity r Partnership r Corporation

r Missouri Corporation - Missouri Charter No. _________________________

Date Incorporated (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___ ___ ___

r Non-Missouri Corporation - Missouri Charter No. ______________________

State of Incorporation _________________________ Date Registered in Missouri (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___ ___ ___

6. Is there a previous owner or operator for the business? r Yes* r No *If yes, the following section must be completed.

Information

Select any of the following that you purchased from the previous owner:

r Inventory

r Fixtures r Equipment

r Real Estate

r Other __________________________________________________________________________________________________________

_____________________________________________________________________

Owner

Purchase Price

Name of Previous Owner or Operator

Missouri Tax Identification Number

Physical Location of Previous Business

City

State

ZIP Code

Address of Previous Business

City

State

ZIP Code

*14606010001*

14606010001

Mailing and Storage Address

Officers, Partners, or Members

Retail Sales, Consumer’s or Vendor’s Use Tax Representatives

Reporting forms and notices will be mailed to this address.

7. Address (street, rural route or P.O. Box)			City		State	ZIP Code

Company Name if different than owner

Which forms do you want mailed to this address?
r All Tax Types	r Sales and Use Tax	r Corporate Income Tax		r Employer Withholding Tax

Address where you will store your tax records (do not use a P.O. Box for record storage).

8. Physical Address			City		State	ZIP Code

9.Provide the officers, partners, or members (L.L.C.) of your business who are responsible for the collection and remittance of tax. Listing individuals or entities here indicates they have direct supervision or control over tax matters. Attach list if needed.

Name (Last, First, Middle Initial)

Title

Social Security Number

Federal Employer ID Number (FEIN)

Date of Birth (MM/DD/YYYY)

___ ___/___ ___/___ ___ ___ ___

Home Address

City

State

ZIP Code

County

Title Begin Date (MM/DD/YYYY)

___ ___/___ ___/___ ___ ___ ___

Name (Last, First, Middle Initial)

Title

Social Security Number

Federal Employer ID Number (FEIN)

Date of Birth (MM/DD/YYYY)

___ ___/___ ___/___ ___ ___ ___

Home Address

City

State

ZIP Code

County

Title Begin Date (MM/DD/YYYY)

___ ___/___ ___/___ ___ ___ ___

10.Business Tax Accounts: Identify all persons who are not a partner, member (L.L.C), or officer of the business that have direct supervision or control over tax matters whom you authorize the Department to discuss your tax matters. Attach list if needed.

Title Begin or End Date (MM/DD/YYYY)

Name (Last, First, Middle Initial)

__ __ / __ __ / __ __ __ __

Title

Social Security Number

Birthdate (MM/DD/YYYY)

__ __ / __ __ / __ __ __ __

Home Address

City

State

ZIP Code

County

11.Taxable Sales or Purchases Begin Date (MM/DD/YYYY) ___ ___/___ ___/___ ___ ___ ___

12.Temporary License (Less than 191 days) (MM/DD/YYYY)

(Example: fireworks, temporary event, etc.) Begins ___ ___/___ ___/___ ___ ___ ___ Ends ___ ___/___ ___/___ ___ ___ ___

13. Seasonal Business: If you do not make taxable sales year round, please check the months that you do.

rJanuary r February r March r April r May r June r July r August r September r October r November r December

14.Estimated sales and use tax liability (select one). Your selection will determine your return filing frequency.

r Monthly (Over $500 a month)

r Quarterly ($500 or less a month)

r Annual (Less than $200 a quarter)

*14606020001*

14606020001

Business Name and Physical Location

Business Activity

Out-of-State Company

15. Business Name (DBA name: attach list if necessary for additional locations)

Street, Highway (Do not use P.O. Box Number or Rural Route Number)		City

County	State	ZIP Code	Business Telephone Number
			(___ ___ ___)___ ___ ___-___ ___ ___ ___

16.Will sales be made at various temporary locations in Missouri?

r No r Yes—Attach a list of all known locations. If no Missouri location is given during initial registration, a general location will be used.

17.Is this business located inside the city limits of any city or municipality in Missouri?

To verify go to mytax.mo.gov/rptp/portal/home/business/salesUseTaxRateInformation

r No r Yes — Specify the city: _________________________________________________________________________

18.Is this business located inside a district(s)? For example, ambulance, fire, tourism, community or transportation development.

rNo r Yes — Specify the district name(s): ________________________________________________________________

19.Describe the business activity, stating the major products sold and services provided.____________________________________________

________________________________________________________________________________________________________________


r Retail _____% r Wholesale _____%			r Service _____% r Manufacturer r Contractor r Other _______________


20.	Do you make retail sales of the following items?		Select all that apply.
	r Alcoholic Beverages	r Alternative Nicotine r Cigarettes or Other Tobacco Products r Domestic Utilities
	r E-Cigarettes or Vapor Products r Food Subject to Reduced State Food Tax Rate r Items Qualifying for Show Me Green Sales Tax Holiday
	r Items Qualifying for Back-To-School Sales Tax Holiday dor.mo.gov/taxation/business/tax-types/sales-use/holidays/			r Lead-Acid Batteries
	r New Tires r Post-Secondary Educational Textbooks r Telecommunication Services
	.r Qualifying Utilities or Items Used or Consumed in Manufacturing or Mining, Research and Development, or Processing Recovered Materials.
21.	Do you make retail sales of aviation jet fuel to Missouri customers?			r Yes	r No
	If yes, are your sales made at:
	r A Missouri airport?	r A location outside Missouri and the fuel is transported into Missouri?
	If yes, is the airport located in Missouri and identified on the National Plan of Integrated Airport Systems (NPIAS)?			r Yes	r No
	If yes, provide a list of applicable locations._ _____________________________________________________________________________
22.	Do you use, store, or consume aviation jet fuel in Missouri where the seller does not collect tax?			r Yes	r No
	If yes, is the fuel stored, used, or consumed in an airport that is identified on the NPIAS?			r Yes	r No
	If yes, provide a list of applicable locations: ______________________________________________________________________________
23.	Do you lease or rent motor vehicles that were purchased sales tax exempt, to Missouri customers?			r Yes	r No
	If you are an out-of-state company, will you lease motor vehicles to a........................................................................................Missouri resident where the lease is entered into			r Yes	r No
	outside Missouri and the motor vehicle is delivered outside Missouri?

If you are an out-of-state entity doing business in Missouri, please answer the following questions.

24.	Do you have a location or job site in Missouri?	r Yes	r No
	If yes, attach a list of your locations including address, city, state, zip code and indicate if the location is inside or outside
	the city limits._ ____________________________________________________________________________________________________
25.	Are orders taken from your Missouri customers by telephone, non-resident salesmen, etc.? If resident salesmen, attach	r Yes	r No
	a list where they live and indicate if they are inside or outside the city limits	r Yes	r No
26.	Do your representatives who reside in Missouri:	r Yes	r No
	A. Approve customer orders?	r Yes	r No
	B. Make on the spot sales?	r Yes	r No
	C. Maintain an inventory?	r Yes	r No
	D. Deliver merchandise to the customer?	r Yes	r No
27.	Do you have non-resident representatives, agents, or temporary employees coming into Missouri on a regular basis?	r Yes	r No
	If yes, define the activities performed while in Missouri._ ___________________________________________________________________
	____________________________________________________________________________________________________
28.	Do you have real or tangible personal property in Missouri?	r Yes	r No
	If yes, please describe: ___________________________________________________________________________________

*14606030001*

14606030001

Tax

29. Is this corporation registered with the Internal Revenue Service as a

r Regular or Close Corporation

r Sub Chapter S Corporation

Income

30. Corporation Tax Begin Date in Missouri (MM/DD/YYYY)

Corporation Taxable Year End (MM/DD)

Corporate

___ ___/___ ___/___ ___ ___ ___

___ ___/___ ___

tax is expected to be at least $250, or 6.25% of the Missouri taxable income, check the “Yes” box

r Yes

r No

31. Will the corporation be required to make quarterly estimated Missouri income tax payments? If the Missouri estimated

32. Missouri Withholding Begin Date (MM/DD/YYYY)

How many of your employees will work in Missouri?

___ ___/___ ___/___ ___ ___ ___

33. Estimated employer withholding tax liability (select one). Your selection will determine your return filing frequency.

Estimated monthly gross wages _____________________ X 5.4% = __________________________

r Annually (less than $100 withholding tax per quarter)

r Monthly ($500 to $9,000 withholding tax per month)

r Quarterly ($100 withholding tax per quarter to $499

r Quarter-Monthly (weekly) (over $9,000 withholding tax per month; required

per month)

to pay electronically)

34. Does a parent company file withholding tax reports and receive full compensation for timely filed returns?

r Yes

r No

35. If you do not pay wages year round, please check the months that you do pay wages.

r January r February r March r April r May r June r July r August r September r October r November r December

Withholding Tax Courtesy Mailing Address (a copy of all withholding tax delinquent notices will be mailed to this address)

Tax

36. Business Name (DBA name)

Withholding

Street, Route or P.O. Box

City

(___ ___ ___)___ ___ ___-___ ___ ___ ___

County

State

ZIP Code

Business Telephone Number

Employer

Transient Employer

37.

Are you a transient employer?

r Yes

r No

An employer not domiciled in Missouri and temporarily transacting business in Missouri for less than 24 consecutive months is defined as a transient employer.

(Example: contractor, temporary staffing agency, etc.). For additional information, contact the Department at businesstaxregister@dor.mo.gov or call

(573) 751-0459. If you have indicated that you are a transient employer, you must complete the entire Employer Withholding Tax Section above.

A transient employer must submit the following with this application:

Missouri Employment Security Account Number

• A completed insurance certification slip indicating Missouri as a covered state for worker’s compensation

• Missouri Employment Security Account number, if hiring a Missouri resident: (first seven digits required)

• Your Missouri Certificate of Authority Number issued by the corporate division of the Missouri Secretary of State’s Office

• A Transient Employer Bond not less than $5,000

Calculate your transient employer bond:

A. Missouri withholding tax

Monthly gross wages _______________________

X 5.4% = _____________________ X 3 = ____________________________ (a)

B. Missouri unemployment tax

Average # of workers __________ X $7,000 = __________________ X 3.38% __________________ / 4 = ___________________ (b)

(a) ___________________________ + (b) ___________________ = ______________________________ (amount of bond - minimum $5,000)

Visit dor.mo.gov/forms/?formName=&category=13&year=99 for bond forms.

Type of bond r Cash Bond (Form 332) r Certificate of Deposit (Form 4172) r Irrevocable Letter of Credit (Form 2879) r Surety Bond (Form 331)

Comments:

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. This application must be signed by the owner, if the business

is a sole proprietorship, or by an individual listed in the Officer, Partners, or Members section of this application. The signing party is acknowledging that they have direct supervision or

control over tax matters.

Signature

Title

Date (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___

___ ___

Typed or Printed Name

E-mail Address

Confidentiality of Tax Records

Missouri Statute 32.057, RSMo, states that all tax records and information maintained by the Missouri Department of Revenue are confidential. The tax information can

only be given to the owner, partner, member, or officer who is listed with us as such. If you wish to give an employee, attorney, or accountant access to your tax information,

you must supply the Department with a power of attorney to grant the authority to release confidential information to them. Visit dor.mo.gov/forms to obtain a Power of

Attorney (Form 2827).

	Mail to: Taxation Division	Form 2643A (Revised 08-2021)
	Mail to: Taxation Division
	P.O. Box 357	Visit dor.mo.gov/register-business/ for additional information.
	Jefferson City, MO 65105-0357	Ever served on active duty in the United States Armed Forces?

	Phone: (573) 751-5860	If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible
	Phone: (573) 751-5860	military individuals. A list of all state agency resources and benefits can be found at
	Fax: (573) 522-1722
	Fax: (573) 522-1722	veteranbenefits.mo.gov/state-benefits/. 14606040001
	E-mail: businesstaxregister@dor.mo.gov	veteranbenefits.mo.gov/state-benefits/. 14606040001

4	14606040001

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Enter the appropriate details in the area Owner Name Enter Corporation LLC, Address, City, Email Address, State, ZIP Code, County, If an individual is listed as the, Social Security Number, Date of Birth MMDDYYYY, Telephone Number, Ownership Type r Sole Proprietor, All ownership types listed below, r Limited Partnership LP Number, and r Not Required to register with.

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