Fillable Form 2643A Missouri Tax Registration Application

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Form 2643A Missouri Tax Registration Application

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The Form 2643A Missouri Tax Registration Application form is 4 pages long and contains:

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  • 70 check-boxes
  • 207 other fields

Country of origin: US
File type: PDF

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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
2643A
Missouri Tax Registration Application
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
1
* Bond Required
*14606010001*
14606010001
Please print on white paper only
It is not necessary to type hyphens or dashes.
Reset ALL PAGES of Form
Print ALL PAGES of Form
2
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 Annually (less than $100 a quarter)
*14606020001*
14606020001
3
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
r Retail _____% r Wholesale _____% r Service _____% r Manufacturer r Contractor r Other _______________
17. Is this business located inside the city limits of any city or municipality in Missouri?
To verify go to https://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.
r No 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?
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.
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 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 http://dor.mo.gov/business/sales/taxholiday/ 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 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 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
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? .......................................................................................................................... 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
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:
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: ___________________________________________________________________________________
If you are an out-of-state entity doing business in Missouri, please answer the following questions. .
*14606030001*
14606030001
4
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 6.25% of the Missouri taxable income, check the “Yes” box. ...................................... r Yes r No
Mail to: Taxation Division Phone: (573) 751-5860
P.O. Box 357 Fax: (573) 522-1722
Jefferson City, MO 65105-0357 E-mail: businesstaxregister@dor.mo.gov
Visit
http://dor.mo.gov/business/register/
for additional information.
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:
• 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 http://dor.mo.gov/forms/index.php?category=13 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 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 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 http://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 2643A (Revised 04-2019)
Missouri Employment Security Account Number
*14606040001*
14606040001
No digital signatures allowed
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Form 2643A Missouri Tax Registration Application

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Completed 21 February 2020

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