What’s Inside . . .
Detailed Instructions .........................................................................................Pages 1 and 2
Form 2643, Missouri Tax Registration Application ............................................... Pages 3 – 6
Bond Instructions ..........................................................................................................Page 7
Business Buyer Beware ................................................................................................ Page ii
Acceptable Bond Types ................................................................................................Page 7
Checklist for Completing Application
- Social security number, address, and birthdate of each owner, officer, partner, or member.
- Physical address and mailing address for your business.
- Federal Employer Identification Number (FEIN) for your business. Visit irs.gov or call 1-800-829-4933
-
Sales or use tax—You will need to know your estimated monthly sales so we can determine your filing frequency.
- Withholding tax—You will need to know your estimated monthly wages paid, so we can determine your withholding filing
frequency.
-
Corporation or limited liability company—You should have your charter number or certificate of authority number from the
Missouri Secretary of State. (Most corporations and limited liability companies are required to obtain a charter number or
certificate of authority number to operate in Missouri.)
-
If the business has a previous owner, you will need to know the previous owner’s name and address. If possible, please
provide the previous owner’s tax identification number and the purchase price.
-
Power of Attorney (Form 2827) —If you would like to allow someone other than the listed owner(s) to sign the application
or handle tax matters with the Department of Revenue (Department), a Power of Attorney (Form 2827) must be completed
and signed by the appointee and a listed owner or member or officer and submitted to the Department with this application.
(Visit our website at dor.mo.gov/forms/ to obtain Power of Attorney (Form 2827).
Mail the application and bond to: Missouri Department of Revenue, P.O. Box 357, Jefferson City, MO 65105-0357 or call
(573) 751-5860 for assistance (TTY (800) 735-2966).
If you have questions relating to specific tax types, please refer to the following e-mail address:
Corporate Income Tax .......................... [email protected]
Sales or Use Tax .................................. [email protected]
Withholding Tax .................................... [email protected]
Business Tax Registration .................... [email protected]
Form 2643 (Revised 10-2023)
Missouri Tax Registration Application
You can also complete your registration online by visiting our website at
dor.mo.gov/register-business/
For sales, use and withholding tax facts, sales tax rates, and FAQs,
visit our website at dor.mo.gov/taxation/business/.
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Business Buyer Beware
Whose unpaid taxes will you be paying?
Find out the facts!!!
You may be liable as a successor!
• Every person purchasing a business or stock of goods immediately shall notify the Director of Revenue of the
business name, owner’s name, date of purchase, and type of business or stock of goods.
• All successors or purchasers shall withhold a sufficient amount of the purchase money to cover taxes, interest, or
penalties due and unpaid by all former owners or predecessors, whether immediate or not, until the former owners
or predecessors produce a receipt from the Director of Revenue showing that they have been paid or a certificate
stating that no taxes are due; otherwise, the successor or purchaser shall become personally liable for the unpaid
tax, penalty, and interest accrued.
Example: Mr. Smith purchases a business from Mr. Jones for $50,000. He acquires all the inventory. He does not
ask Mr. Jones for a Certificate of No Tax Due. Mr. Smith comes in to apply for a Missouri Tax I.D. Number and
receives it. However, because Mr. Smith did not obtain a Certificate of No Tax Due from Mr. Jones, after receiving his
license for the business he finds Mr. Jones has sales tax delinquencies totaling $20,000, which he must pay because
he is now successor. Mr. Smith is now paying two people for the business — Mr. Jones and the Department.
• All purchasers have a duty to discover whether taxes are due and unpaid by any former owner or predecessors,
whether immediate or not, and a lack of knowledge about successorship will not relieve a purchaser from successor
tax liability. Reliance on an affidavit pursuant to Missouri’s Bulk Transfer Act stating there were no creditors of the
business will not relieve a purchaser from successor tax liability.
Some questions you may want to ask yourself when purchasing a business:
1) Are you purchasing the building (real estate)?
2) Are you purchasing the inventory?
3) Are you purchasing the equipment?
4) Are you purchasing the fixtures?
If you answer “yes” to any of the above questions, please obtain a Certificate of No Tax Due for sales tax (or a Tax
Clearance if the seller had employer withholding tax or other tax types) from the seller before you purchase the
business.
If you have any questions concerning successorship, please call (573) 751-2836 or write the Department of Revenue,
Business Tax, P.O. Box 3390, Jefferson City, MO 65105-3390.
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 of Revenue 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 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 of Revenue’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.
Federal Privacy Notice
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Instructions
Please review the instructions below before completing the application and if you have any questions,
contact Business Tax Registration.
1. Missouri Tax I.D. Number: If you have ever been issued a Missouri Tax I.D. Number by the Missouri Department of Revenue, enter it here.
If you do not have one, leave this field blank.
2. You may be required to submit a Federal Employer Iden ti fi ca tion Number (FEIN) to complete your business registration. The FEIN is issued
by the Internal Revenue Service (IRS). The FEIN is used to identify taxpayers that are required to file various business tax returns. Em ployers,
corporations, partnerships, limited liability companies, trusts and estates, and other business entities are required to have a FEIN. For more
information regarding FEINs or to obtain a number online, please contact the IRS at (800) 829-4933 or visit their website at irs.gov.
5. Ownership Type: Check the appropriate ownership type for your business. Be sure to include your charter number, certificate of
authority number, limited partnership number, limited liability partnership number, or limited liability number issued by the Secretary of State.
If you are a non-Missouri corporation, in clude the state of incorporation and date issued.
6. Previous Owner: If a business was previously operated at this location or you purchased any portion of the business from a previous owner,
You must complete this section. Protect yourself by obtaining a copy of a “No Tax Due” statement from the previous owner of the
business. The Department only issues this statement if requested by the previous owner and all sales or use taxes are paid in full. See page
ii for Business Buyer Beware.
7. Business Mailing Address: The Department mails reporting forms as well as confidential and non-confidential correspondence to the business
address listed on #4. If you want us to direct your mail to an address other than the business address for any of your taxes, enter that
address here and check the appropriate boxes. If this address is for a different company, please indicate that companies name.
9. Officers, Partners, and Mem bers: Identify all officers, partners, and members of your business who are responsible for the collection and
remittance of tax. If you are a sole owner and you completed the “Owner Information” on #19, you do not have to complete this section. If the
business is a partnership or limited liability partnership, enter all partners. If it is a limited partnership, include only the general partners.
If the business is owned by another corporation or LLC, please include that entity in the list of officers or members including the FEIN of that
corporation or LLC. Complete all information for each officer, partner, and member, including social security number and date of birth. Your
registration will not be complete unless we receive all requested information. Attach a list of officers, partners, and members if you cannot fit
them all on this page.
10. Authorized Representatives: 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. All other persons must obtain
a Missouri Power of Attorney (Form 2827). Complete all information for authorized representative(s), including social security number
and date of birth. Your registration will not be complete unless we receive all requested information. Attach a list if needed.
11-14. Sales or Use Tax: Complete this section if you are going to make retail sales subject to sales, vendor’s use, or consumer’s use tax.
Consumer’s Use Tax: Unlike sales tax, which requires a sale at retail in Missouri, use tax is imposed directly upon the person who stores,
uses, or consumes tangible personal property in Missouri. Use tax does not apply if the purchase is from a Missouri retailer and
subject to Missouri sales tax. A seller not engaged in business is not required to collect Missouri tax but the purchaser in these
instances is responsible for remitting use tax to Missouri. If an out-of-state seller does not collect use tax from the purchaser, the
purchaser is responsible for remitting the use tax to Missouri. A purchaser is required to file a use tax return if the cumulative purchases
subject to use tax exceed $2,000 in a calendar year.
Effective July 30, 2021, all businesses reporting sales or use tax from 3 or more locations, are required to file sales and use tax return(s)
electronically. Returns can be conveniently filed electronically through the secure MyTax Missouri Portal at, mytax.mo.gov.
Vendor’s Use Tax: If an out-of-state vendor makes sales of goods to a final consumer located in Missouri and the vendor has substantial
nexus with Missouri, the vendor is required to collect and remit Missouri vendor’s use tax.
11. Retail Sales Tax License cannot be issued without a taxable begin date. If you are a seasonal business, check the months in which you
will make sales. We will only require you to file a return in the months you check.
14. Filing Frequency: Your filing fre quency is determined by the amount of state sales tax due. Multiply your anticipated month ly taxable sales
by 4 percent to arrive at your estimated monthly liability.
15. Business Name and Phys i cal Location: Enter all information regarding the physical location of your business, including your business name.
Do not use a PO Box or Rural Route Number for this address. If you make retail sales, this is the address we will print on your license. If you
have more than one location, attach a sheet listing the additional locations.
16. If sales will be made from various temporary locations, (for example, craft shows and food trucks), provide the list of these locations.
If you do not know where your next location will be, a general location will be used for registration purposes. As soon as you know the
location where your sales will take place, please notify the Department at [email protected] or call (573) 751-5860.
17-19. City Limits or District(s): Determine whether you are inside a city’s limits or a district(s). If you are registering for sales tax, this will ensure
we register you to collect and remit the correct tax rate.
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20. Retail Sales of Certain Items.
r Food Tax: Food or food products for home consumption. dor.mo.gov/taxation/business/tax-types/sales-use/reduction-on-food.html
r Lamar Heights Section 94.838, RSMo, adds an additional 2% tax to the sales tax rate if you are a restaurant, café, cafeteria, or lunchroom.
r Branson 1% ExemptionSection 94.802, RSMo, reduces the 1% Branson/Lakes Area Tourism Enhancement District Sales Tax to 0%
for hotels and amusement within the municipality.
r Branson 1/8% Exemption Section 94.805, RSMo, Branson business defined within this section, include Branson/Lakes
Area Tourism Enhancement District sales tax is reduced to 7/8%.
r Branson 1/8% Exemption Section 94.805, RSMo, exempts certain back-to-school purchases, such as clothing, school supplies,
computers, and other items as defined by the statute, during a period from 12:01 a.m. the first Friday in August and ending at
midnight on the Sunday following.
rBranson 1/8% Exemption Section 94.805, RSMo, exempts up to $1,500 for certain Energy Star certified appliance purchases, such
as furnaces, clothes washers and dryers, water heaters, trash compactors, dishwashers, conventional ovens, ranges, stoves, air conditioners,
refrigerators and freezers and other items as defined by the statue, during a period from 12:01 a.m. on April 19th and ending at midnight
on April 25th.
rA fifty cent (.50) tire fee applies to the retail sale of all new tires designed for use on trailers and self-propelled vehicles not operated
exclusively on tracks. A fifty cent (.50) battery fee applies to the retail sale of batteries that contain lead and sulfuric acid with a nominal
voltage of at least six volts and are intended for use in motor vehicles and watercraft.
23. Motor Vehicle Leasing Sales Tax: Indicate whether or not your company will lease motor vehicles that were purchased tax exempt
because the exemption for motor vehicles purchased for leasing was claimed. Your company will be responsible for charging the
retail sales rate of tax where the lessee is located. (This includes leases that are completed between a Missouri dealer, as your agent, and
a Missouri customer, even if your out of state company is carrying the lease).
Motor Vehicle Leases from Out of State: Indicate if your company is an out of state company that leases motor vehicles to a Missouri
resident where the lease is entered into outside Missouri and the motor vehicle is delivered to the lessee outside Missouri. Your company
will be responsible for charging the highway sales tax rate where the lessee is located. You will need to provide a list of the lessee’s locations
in Missouri.
24-28. Out-of-State Businesses: Only out-of-state businesses need to complete this section. It helps us determine whether you should report
sales tax, use tax, or withholding tax.
24a. Marketplace Facilitator: An entity or person who operates a website or service where customers can buy good or services from many
different vendors.
For more information, visit dor.mo.gov/faq/taxation/business/remote-seller-and-marketplace-facilitator.html.
29-31. Corporate Income or Franchise Tax: Businesses taxed as a corporation by the Internal Revenue Service must complete this section.
32-35. Withholding Tax: The withholding tax filing frequency is based upon the amount of withholding tax you will be remitting to the De partment.
If you will be remitting over $9,000 in withholding tax per month, you are required to pay quarter-monthly (weekly). Your payment(s) should
be sent to the De part ment electronically. Currently, there are two methods available for electronic filing and payment:
1.) ACH credit through the Department’s TXP bank project; and
2.) Internet filing through a MyTax Missouri portal account, or business tax guest filing.
For information on electronic filing through ACH credit, visit dor.mo.gov/taxation/business/efile.html send an e-mail to [email protected],
or call (573) 751-3900. For information on electronic filing through the Internet, visit mytax.mo.gov.
36. Courtesy Mailing Address: We will mail certain duplicate withholding notices to an address other than your mailing address (for example,
owner address).
37. Transient Employer: If de fined as a transient em ployer pursuant to Title XVIII, Chapter 285.230, RMSo, please calculate the amount of your
bond. If you are unsure if you qualify as a transient employer or require transient employer bond forms, please contact the Taxation Division,
P.O. Box 357, Jef fer son City, MO 65105-0357 or call (573) 751-0459 (TTY (800) 735-2966).
Signature: An owner, officer, partner, member or responsible party must sign the application and be listed as an owner. If a power of attorney
signs the application, you must include a Power of Attorney (Form 2827) signed by an owner listed on the application.
Confidentiality: To ensure your tax records are protected and confidential, the De part ment will not release tax information to anyone who is
not listed in our records as an owner, partner, member, or officer for your business. If your partners, members, or officers change, you must
update your registration with the Department by completing Registration or Exemption Change Request (Form 126), before we can release
tax information to those new partners, members, or officers. If you would like the Department to release tax information to an accountant,
tax preparer, or another individual who is not listed on your account, please complete a Power of Attorney Form. (Visit our website at
dor.mo.gov/forms/ to obtain Power of Attorney (Form 2827).
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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.
rLimited Partnership - LP Number __________________________________
rLimited Liability Partnership - LLP Number ___________________________
rLimited Liability Company - LLC Number ____________________________
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) ___ ___ / ___ ___ / ___ ___ ___ ___
3. Select all tax types for which you are applying:
Sales from a Missouri business location
rRetail Sales
rTemporary Retail Sales (Less than 191 days)
rRetail Liquor or Alcohol Sales
Sales or Purchases from an out-of-state location
r Vendor’s Use
r Consumer’s Use (Missouri purchases
where tax is not collected.)
Missouri Employer Withholding Tax
rRegular Withholding
rDomestic or Household Employee
rTransient Employer*
Corporate Tax
rCorporate Income
rCorporate Franchise
Reason for Application
r New MO Registration
r Purchase of Existing Business
r Reinstating Old Business
r Converted (must have converted
through the Missouri Secretary of
State’s Office)
r Court Appointed Receiver
r Other:
Reason for Applying
Answer all questions completely. Incomplete and unsigned applications will delay processing..
Form
2643
Missouri Tax I.D.
Number
(Optional)
Federal Employer
I.D. Number
Department Use Only
(MM/DD/YY)
4. Owner Name (Enter Corporation, LLC or Partnership Name, if applicable)
Address E-mail Address
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
| | | | | | | |
Owner Information
___ ___ / ___ ___ / ___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Ownership Type
rNot Required to register with Missouri Secretary
of State
r Other
Previous Owner Information
6. Is there a previous owner or operator for the business? rYes* rNo *If yes, the following section must be completed.
Name of Previous Owner or Operator
Physical Location of Previous Business City State ZIP Code
Address of Previous Business City State ZIP Code
Select any of the following that you purchased from the previous owner: r Inventory rFixtures r Equipment rReal Estate
r Other __________________________________________________________________________________________________________
_____________________________________________________________________
Missouri Tax Identification Number
| | | | | | |
Purchase Price
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* Sales & Use Tax bond not required unless requested by the Department of Revenue
** Bond required for Transient Employer
Missouri Tax Registration Application
Print ALL PAGES of Form
Reset ALL PAGES of Form
Please print on white paper only
It is not necessary to type hyphens or dashes.
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8. Physical Address City State ZIP Code
Address where you will store your tax records (do not use a P.O. Box for record storage).
Mailing and Storage Address
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
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
Officers, Partners, or Members
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)
| | | | | | | |
___ ___/___ ___/___ ___ ___ ___
| | | | | | | |
___ ___/___ ___/___ ___ ___ ___
Representatives
10. Business Tax Accounts: Identify all persons who are not a partner, member (L.L.C), or ofcer 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
| | | | | | | |
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
Retail Sales, Consumer’s or Vendor’s Use Tax
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.
r January 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 ling frequency.
r Monthly (Over $500 a month) r Quarterly ($500 or less a month) r Annual (Less than $200 a quarter)
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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
rRetail _____% rWholesale _____% rService _____% rManufacturer rContractor rOther _______________
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
rNo 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. ___________________________________________
_________ _______________________________________________________________________________________________________
16. Will sales be made at various temporary locations in Missouri?
rNo rYes—Attach a list of all known locations. If no Missouri location is given during initial registration, a general location will be used.
Business Name and Physical Location
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Business Activity
20. Do you make retail sales of the following items? Select all that apply.
rAlcoholic Beverages rAlternative Nicotine rBranson Hotel-Amusement Exemption rBranson Restaurant & Drink Exemption
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Lamar Heights Additional Restaurant Tax rLead-Acid Batteries r New Tires r Post-Secondary Educational Textbooks
rTelecommunication Services
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 identied 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 identied 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 rNo
If you are an out-of-state company, will you lease motor vehicles to a Missouri resident where the lease is entered into
outside Missouri and the motor vehicle is delivered outside Missouri? ........................................................................................ r Yes rNo
Out-of-State Company
24. Do you have a location or job site in Missouri? .......................................................................................................................... rYes rNo
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. ____________________________________________________________________________________________________
24a. Are you a Marketplace Facilitator that facilitates retail sales of tangible personal property or taxable services? ................. rYes rNo
If yes, do you make sales statewide requiring registration of all applicable taxing jurisdictions? ......................................... rYes rNo
25.
Are orders taken from your Missouri customers by telephone, non-resident salesmen, etc.? If resident salesmen, attach
a list where they live and indicate if they are inside or outside the city limits............................................................................. r Yes rNo
26.
Do your representatives who reside in Missouri:
A. Approve customer orders? ..................................................................................................................................................... rYes rNo
B. Make on the spot sales? ........................................................................................................................................................ rYes rNo
C. Maintain an inventory? ........................................................................................................................................................... rYes rNo
D. Deliver merchandise to the customer? .................................................................................................................................. rYes rNo
27.
Do you have non-resident representatives, agents, or temporary employees coming into Missouri on a regular basis? ......... rYes 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: ___________________________________________________________________________________
If you are an out-of-state entity doing business in Missouri, please answer the following questions. .
Condentiality of Tax Records
Corporate Income Tax
29. Is this corporation registered with the Internal Revenue Service as a r Regular or Close Corporation r Sub Chapter S Corporation
30. Corporation Tax Begin Date in Missouri (MM/DD/YYYY) Corporation Taxable Year End (MM/DD)
___ ___/___ ___/___ ___ ___ ___ ___ ___/___ ___
31. Will the corporation be required to make quarterly estimated Missouri income tax payments? If the Missouri estimated
tax is expected to be at least $250, or 4% of the Missouri taxable income, check the “Yes” box . .......................................... r Yes r No
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 [email protected] 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:
• 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 4.95% = _____________________ 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 Certicate of Deposit (Form 4172) r Irrevocable Letter of Credit (Form 2879) r Surety Bond (Form 331)
Withholding Tax Courtesy Mailing Address (a copy of all withholding tax delinquent notices will be mailed to this address)
Transient Employer
Employer Withholding Tax
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 4.95% = __________________________
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 le withholding tax reports and receive full compensation for timely led 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
36. Business Name (DBA name)
Street, Route or P.O. Box City
County State ZIP Code Business Telephone Number
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Signature
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).
Signature Title Date (MM/DD/YYYY)
Typed or Printed Name E-mail Address
___ ___ / ___ ___ / ___ ___ ___ ___
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.
Comments:
Form 2643 (Revised 10-2023)
*14605040001*
14605040001
Missouri Employment Security Account Number
Visit dor.mo.gov/register-business/ for additional information.
Mail to:
Taxation Division
P.O. Box 357
Jefferson City, MO 65105-0357
Phone: (573) 751-5860
Fax: (573) 522-1722
E-mail: [email protected]
Ever served on active duty in the United States Armed Forces?
If yes, visit dor.mo.gov/military/ to see the services and benets we offer to all eligible
military individuals. A list of all state agency resources and benets can be found at
veteranbenets.mo.gov/state-benets/.
Transient Employer: Missouri Statute 285.230, RSMo, a transient employer must file a bond with the Department unless they meet all the exemption
criteria listed in 285.230(2). The amount of bond shall not be less than the average estimated quarterly withholding and unemployment tax
liabilities of the employer and in no case less than $5,000 nor more than $25,000.
*** Important: If you are a transient employer and fail to file a bond, you are in violation of Missouri law. You may be guilty of a misdeameanor and
penalized up to $5,000 and will not be able to perform work in Missouri.
*** Sales & Use Tax bonds are only required if requested by The Department of Revenue.
Cash Bond (Form 332)
1. Fully complete the cash bond form. Owners name must include owner, all partners, corporation, or LLC name.
2. Sign the cash bond form.
3. Forward a cashier’s check, money order, or certified check with the cash bond form. Cash, personal, or company checks are not acceptable.
Surety Bond (Form 331)
1. Owners name must include owner, all partners, corporation, or LLC name.
2. A surety bond must be issued by an insurance company licensed for bonding with the Department of Insurance, State of Missouri.
3. It must be on the form provided by the Department.
4. The form must bear the effective date.
5. It must be signed by an authorized representative of the surety company and the owner, partner, officer, or member.
6. The Surety Bond must be accompanied by a valid Power of Attorney letter, issued by the surety company, authorizing the surety official to sign
the Surety Bond.
7. It must be the original bond. A copy is not acceptable.
Irrevocable Letter of Credit (Form 2879)
1. Owners name must include owner, all partners, corporation, or LLC name.
2. The letter of credit must be issued by a financial banking institution located in the United States.
3. It must be on the form provided by the Department.
4. It must be the original letter of credit. A copy is not acceptable.
5. It must state the owner’s name.
6. It must state the date of issuance.
7. It must be signed by a bank official and notarized.
8. It must be accompanied by an “Authorization for Release of Confidential Information” form which must be signed by the owner, partner, officer, or
member and notarized.
Certificate of Deposit (Form 4172)
1. The Certificate of Deposit must be issued by a state or federally chartered financial institution.
2. The Certificate of Deposit must be issued in the name of the Missouri Department of Revenue and the owner, all partners, corporation name or
limited liability company name.
3. It must be issued for not less than 24 months.
4. It must be accompanied by the “Assignment of Certificate of Deposit” form provided by the Department which must be completed by the
financial institution.
5. The Certificate of Deposit must be endorsed or accompanied by a signed withdrawal slip.
6. The actual Certificate of Deposit, Assignment of Certificate of Deposit, and a copy of the signature card must be forwarded with the
registration application.
Sales and Use Tax and Transient Employer Bond Information
Form 2643 (Revised 10-2023)
*14000000001*
14000000001
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