Form
332
________________________________________________________________(Taxpayer) hereby files with the
Missouri Department of Revenue this cash bond and the attached cashier’s check or money order in the amount of
___________________________________________________________________ ($___________________________).
Taxpayer understands that it is required to comply with all the provisions of any statutorily or constitutionally authorized state
or local tax.
If Taxpayer becomes delinquent and owes the Department the above indicated tax, related fees, interest, additions to tax,
and penalties due the state of Missouri, the Director of Revenue may forfeit this bond and apply it to any unpaid
delinquencies.
Delivery of any demands, notice, or service of process by the Department shall be deemed sufficient and made in the
state of Missouri if personally served or if mailed by U.S. mail to the taxpayer or business address as set forth above.
This cash bond and any legal action pertaining thereto shall be governed by and construed in accordance with the laws of
the state of Missouri. The parties understand and agree that the exclusive jurisdiction for any action concerning this bond
shall be the state of Missouri and the only venue shall be in the Circuit Court of Cole County, Missouri.
By signing this cash bond, the undersigned states that he or she has authority to bind the taxpayer or business identified
herein.
Owner, Partner, Corporate Officer or LLC Member Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Sign
Amount (U.S. Currency - No personal or company checks) Date (MM/DD/YYYY)
At the request of Taxpayers or Business (Owner’s name, all Partners, Corporation, or LLC Name)
Taxpayer or Business Owner’s Address City
County State Zip Code E-mail Address
__ __ / __ __ / __ __ __ __
$
Form 332 (Revised 02-2015)
Mail to:
Sales and Use or Transient Employer
Withholding Motor Fuel Tax Cigarette Tax Other Tobacco Products
Taxation Division Taxation Division Taxation Division Taxation Division
P.O. Box 357 P.O. Box 300 P.O. Box 811 P.O. Box 3320
Jefferson City, MO 65105-0357 Jefferson City MO 65105-0300 Jefferson City MO 65105-0811 Jefferson City, MO 65105-3320
Phone: (573) 751-5860 Phone: (573) 751-2611 Phone: (573) 751-7163 Phone: (573) 751-5772
Fax:
(573) 522-1722 Fax: (573) 522-1720 Fax: (573) 522-1720 Fax: (573) 522-1720
E-mail: businesstaxregister@dor.mo.gov
E-mail: excise@dor.mo.gov E-mail: excise@dor.mo.gov E-mail: excise@dor.mo.gov
Visit http://dor.mo.gov/business/register/ for additional information. TTY (800) 735-2966
Select only one:
r Sales and Use Tax r Motor Fuel Tax
r Other Tobacco Products Motor Fuel license type (Select One):
r Cigarette Tax r Supplier or Permissive Supplier r Distributor
r Transient Employer Withholding and Unemployment Tax r Terminal Operator r Transporter
Cash Bond Type
Personal or company checks will not be accepted as payment. Please remit a cashier’s check or money order.
*14602010001*
14602010001
Department Use Only
(MM/DD/YY)
Federal Employer
I.D. Number
Cash Bond
Missouri Tax I.D.
Number
(Optional)
Please print on white paper only
No digital signatures allowed
