Fill - Free fillable EATs Summary Form

{File: EDCKC/60/ADM/ADMST/99/00216023/216024}

TAX INCREMENT FINANCING

Economic Activity Tax (EATs) Summary Form

Period/s of Submission:

Half 20

(Jan. – June, due July 31st)

(July – Dec., due January 31st)

Business Name (dba):

Business Address (local):_

Conta

t Nam

e/Telephone:

E-Mail Address:

Individual Earnings Tax, Net Profits Tax, Convention & Tourism Tax:

Federal Identification Number (FEIN):

1. Total Employees Working in Kansas City, MO:

2. Total Employees Working in TIF Plan Area:

Percentage of Employees in TIF Plan Area (divide line 2 by line 1):

Missouri Sales and Use Tax:

Missouri Tax Identification Number (8 digits):

Business Location Code: Sales Tax (38000-XXX-XXXX)

(on MO DOR Sales Tax Return

Form)

Business Location Code: Use Tax (38000-XXX-XXXX)

Utility Tax:

Please provide photocopies reflecting the tax break down portions on the following applicable utility bills for the business

located in the TIF Plan area: (Be sure to provide a copy of each bill for each month within the reporting period.)

Copies supplied N/A (ex. in lease)

Copies supplied N/A



X Electric (KCP&L or Aquila)

X Gas (Missouri Gas or other provider)

X Water (Kansas City MO Water Dept)

X Phone (AT&T, Nuvox, McLeod, or telephone provider)

X Cable (Time Warner or other cable provider, if applicable)

I/We,

(insert name of signator for business), authorize the City of

Kansas City, Missouri Treasury to release the above-referenced confidential tax records pertaining to Economic Activity

Taxes to

(insert county of business) County and the Economic Development Corporation, Tax

Increment Financing Commission.

I/We,

(insert name of signatory for business), in my capacity as

(insert title of signatory), hereby certify that I am authorized by

(insert

authorizing entity), to release such confidential tax information referenced herein and that such records are true and

correct, as of

(insert date), and in the event any such records should be proven incorrect, I will notify The

EDC-EATs Submission Department or City of Kansas City, MO Development Finance at such time at the addresses

shown below.

(Signature) (Date)

Please Fax, PDF email or Mail ONE copy of this completed and signed form along with one copy of the utility bills

referenced herein to:

Fax: 816-691-2182 Mail: TIF Commission

Email: rick.desimone

@kcmo.org or



rdesimone@e

dckc.com o

eats@edckc.com

Attn: EATs Submission

300 Wyandotte, Suite 400

Kansas City, Missouri 64105

Please keep this form for your files. Submissions become automatically due every January 31

and July 31

with or without formal notification from the TIF Commission of Kansas City, Missouri.

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