Missouri Form 943 – Fill Out and Use This PDF

Missouri Tax Identification Number

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Federal Employer Identification Number (FEIN)

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Charter Number

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Business

Name

Mailing Address

Doing Business As Name (DBA)

City	State	ZIP Code

Ownership

Select Ownership Type: Choose One

r Corporation r Partnership r Sole Proprietorship

Limited Liability Company that is taxed as: r Corporation r Partnership r Sole Owner

Corporations

If there has been a name change for this corporation, please provide prior name.

_____________________________________________________________

rThis corporation files consolidated corporation income tax returns in Missouri. Parent Corporation Information:

Missouri Tax Identification Number

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Federal Employer Identification Number
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Sole Proprietorships

If individual income tax returns have been previously filed in another state, please provide a list of the states and years filed. Attach additional page(s) to this form if needed.

Your Social Security Number

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Spouse’s Social Security Number

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Reason for Request

SignatureAuthorization

Select Reason for Request: Choose One

1.I am completing the following transaction with the Missouri Secretary of State’s Office.

r Reinstatement r Withdrawal or Termination r Merger — Date of Merger

All tax types and the account with the Division of Employment Security will be reviewed and must be filed and paid in full.

2.I am completing the following transaction: r Selling Business Assets or Financial Closing r Dept. of Economic Development r Office of Administration Contract Bid greater than $1,000,000 (Page 2 is required.) r Linked Deposit

r Other __________________________________________________________________________________________

All tax types and the account with the Division of Employment Security will be reviewed and must be filed and paid in full.

3.r I require a Vendor No Tax Due to obtain or renew a contract with the state of Missouri. (Page 2 is required.)

All correspondence will be released to the person authorized below. Release of this information to a third party (such as an accountant) at the request of the taxpayer does not give the third party authority to request further information from the Department. To obtain additional information or to represent the taxpayer before the Department, the taxpayer must execute a Power of Attorney designating the third party as its representative.

Name of Person Authorized to Receive This Information	Title		Phone Number
			( _ _ _ ) _ _ _ - _ _ _ _
Address	City	State		ZIP Code
E-mail Address of Authorized Person

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

Signature of Owner or Officer

Title

Phone Number

( _ _ _ ) _ _ _ - _ _ _ _

Printed Name of Owner or Officer

Please email results to:

Mail to: Taxation Division P.O. Box 3666

Jefferson City, MO 65105-3666

Phone: (573) 751-9268

Fax: (573) 522-1265

E-mail: taxclearance@dor.mo.gov	Form 943 (Revised 12-2021)

Ever served on active duty in the United States Armed Forces?

If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible military individuals. A list of all state agency resources and benefits can be found at

veteranbenefits.mo.gov/state-benefits/.

Information

1.Name of state agency or university that the bid or contract is with. ___________________________________________________________

_______________________________________________________________________________________________________________

2.What service(s) or item(s) will be supplied in the bid or contract? ____________________________________________________________

3.	Does the business or individual make taxable sales to Missouri customers?	. . . . . . r Yes	rNo
4.	Does the business or individual have any affiliates (any person or entity that is controlled or under common
	control with the vendor) in the state of Missouri?	. . . . . r Yes	rNo
	If yes, please list the FEIN(s) and Missouri Tax Identification Number(s). Attach a second sheet if needed. ___________________________
	_______________________________________________________________________________________________________________
5.	Do any of the affiliates make taxable sales?	r Yes r No	r N/A

1.What if I don’t know my Missouri tax identification number?

The Missouri tax identification number is assigned by the Missouri Department of Revenue at the time you register for the reporting of sales, use, withholding, corporation income, or corporation franchise tax. If you have not registered your business or need to check on the status of a registration, please contact Business Tax Registration at (573) 751-5860. If you do not have a Missouri Tax Idenification number leave blank.

2.What is my federal employer identification number?

The Internal Revenue Service issues your federal employer identification number when you register to file federal taxes. If you do not have this number, we will review the account based on the information provided.

3.What is my corporation charter number or certificate of authority number?

Your corporate charter number is issued to a Missouri corporation, limited liability company or limited partnership, by the Missouri Secretary of State’s Office, authorizing your company to transact business in the State of Missouri. The certificate of authority number is issued by the Missouri Secretary of State’s Office to foreign entities. Questions concerning these numbers should be directed to the Missouri Secretary of State’s Office at (573) 751-4153.

4.I am a foreign corporation. Am I required to register with the Missouri Secretary of State’s Office?

If you are a corporation, you must be authorized to transact business in the State of Missouri with the Missouri Secretary of State’s Office. Some foreign corporations may not be required to obtain a certificate of authority number in Missouri. If your corporation is not required, indicate so and the reason why. You may review Section 351.572.2, RSMo, for possible reasons a corporation may not be required to register.

5.What are the reasons a corporation is dissolved?

A corporation can be dissolved for failure to file the Annual Report, failure to file and or pay required taxes, failure to maintain a registered agent, and practicing fraud against the state.

6.What are the consequences of being administratively dissolved versus voluntarily dissolved?

If the corporation voluntarily dissolves, it indicates the corporation requested the dissolution. If it is administratively dissolved, the Secretary of State’s Office has dissolved the corporation. If the corporation is administratively dissolved, it could have difficulty when bidding a job in the state, trying to obtain a loan, or when completing a financial closing through a bank. The Secretary of State’s website is: www.sos.mo.gov, and may be viewed for additional information, forms, and the current status of the corporation.

7.Does this request have to be signed by the owner or corporate officer?

Yes, an officer or the owner must sign the request.

8.Is there a fee to request a tax clearance?

No. There is no fee to submit a Request for Tax Clearance.

9.Can I send my Secretary of State application with my tax clearance request form?

No, once you receive the clearance letter it is sent with all required information to the Secretary of State’s Office.

10.Will the Secretary of State’s Office accept a faxed copy of the tax clearance?

Yes, as long as it is within the allotted 60 day timeframe indicated on the clearance letter. Because the letter is only valid for 60 days, you may need to take this into consideration when completing the request for tax clearance and not request it too soon.

If you are requesting a No Tax Due use No Tax Due Request (Form 5522).

If you have questions concerning the tax clearance, please contact the Missouri Department of Revenue, Tax Clearance Unit at (573) 751-9268. The fax number is (573) 522-1265.

If you have questions concerning reinstatements, please contact the Missouri Secretary of State’s Office at (573) 751-4153 or toll free at (866) 223-6535.

The Federal Privacy Act requires the Missouri Department of Revenue (Department) to inform taxpayers of the Department’s legal authority for requesting identifying information, including social security numbers, and to explain why the information is needed and how the information will be used.

Chapter 143 of the Missouri Revised Statutes authorizes the Department to request information necessary to carry out the tax laws of the state of Missouri. Federal law 42 U.S.C. Section 405 (c)(2)(C) authorizes the states to require taxpayers to provide social security numbers.

The Department uses your social security number to identify you and process your tax returns and other documents, to determine and collect the correct amount of tax, to ensure you are complying with the tax laws, and to exchange tax information with the Internal Revenue Service, other

states, and the Multistate Tax Commission (Chapter 32 and 143, RSMo). In addition, statutorily provided non-tax uses are: (1) to provide information to the Department of Higher Education with respect to applicants for financial assistance under Chapter 173, RSMo and (2) to offset refunds against amounts due to a state agency by a person or entity (Chapter 143, RSMo). Information furnished to other agencies or persons shall be used solely for the purpose of administering tax laws or the specific laws administered by the person having the statutory right to obtain it as indicated above. (For the Department’s authority to prescribe forms and to require furnishing of social security numbers, see Chapters 135, 143, and 144, RSMo.)

You are required to provide your social security number on your tax return. Failure to provide your social security number or providing a false social security number may result in criminal action against you.