Attach Federal Return. See instructions
and diagram on page 3 of Form MO-NRI.
Part A
Resident/Nonresident Status - Select your status in the appropriate box below.
Name
Address
City, State, ZIP Code
Social Security Number
- -
Spouse’s Name
Address
City, State, ZIP Code
Spouse’s Social Security Number
- -
1. Nonresident of Missouri
State of residence during 2019 ______________________ State of residence during 2019 ______________________
2. Part-Year Missouri Resident
Indicate the dates you were a Missouri Resident in 2019. Indicate the dates you were a Missouri Resident in 2019.
A. Date From: _______________ Date To: _____________
B. Indicate the other state of residence
Based on the Military Spouse’s Residency Relief Act, if you are the spouse of a military servicemember residing outside of Missouri solely
because your spouse is there on military orders, and Missouri is your state of residence, any income you earn is taxable to Missouri. Do not
complete Form MO-NRI. You must report 100% on Line 28 of Form MO-1040.
3. Military/Nonresident Tax Status - Indicate your tax status
Missouri Home of Record
below and complete Part C - Missouri Income Percentage.
I did not at any time during the 2019 tax year maintain a
permanent place of abode in Missouri, nor did I spend more
than 30 days in Missouri during the year. I did maintain a
permanent place of abode in the state of
_____________ .
Non-Missouri Home of Record
I resided in Missouri during 2019 solely because my spouse
or I was stationed at
_____________________________
on military orders. My home of record is in the state of
and dates you resided there __________________________
B. Indicate the other state of residence
and dates you resided there __________________________
For Privacy Notice, see Instructions.
A. Date From: _______________ Date To: _____________
Date From: _______________ Date To: _____________ Date From: _______________ Date To: _____________
1. Nonresident of Missouri
2. Part-Year Missouri Resident
______________ .
3. Military/Nonresident Tax Status - Indicate your tax status
Missouri Home of Record
below and complete Part C - Missouri Income Percentage.
I did not at any time during the 2019 tax year maintain a
permanent place of abode in Missouri, nor did I spend more
than 30 days in Missouri during the year. I did maintain a
permanent place of abode in the state of
_____________ .
Non-Missouri Home of Record
I resided in Missouri during 2019 solely because my spouse
or I was stationed at
_____________________________
on military orders. My home of record is in the state of
______________ .
MO-NRI Page 1
2019 Missouri Income Percentage
Form
MO-NRI
Reset Form
Print Form
2a
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Part B
Worksheet for Missouri Source Income
Adjusted Gross
Income Computations
A. Wages, salaries, tips, etc. ...................................
B. Taxable interest income.....................................
C. Dividend income ..........................................
D. State and local income tax refunds (from schedule 1, part 1) .......
E. Alimony received (from schedule 1, part 1) .....................
F. Business income or (loss) (from schedule 1, part 1) ..............
G. Capital gain or (loss) .......................................
H. Other gains or (losses) (from schedule 1, part 1) .................
.
A
.
A
I. Taxable IRA distributions....................................
J. Taxable pensions and annuities ..............................
K. Rents, royalties, partnerships, S corporations, etc. (from schedule 1, part 1)
L. Farm income or (loss) (from schedule 1, part 1)..................
M. Unemployment compensation (from schedule 1, part 1) ...........
N. Taxablesocialsecuritybenets ...............................
O. Other income (from schedule 1, part 1) ........................
P. Total - Add Lines A through O ................................
Q. Less: federal adjustments to income ..........................
R. SUBTOTAL(LineP-LineQ)Ifnomodicationstoincome,
S. Missourimodications-additionstofederaladjustedgrossincome
T. Missourimodications-subtractionsfromfederaladjustedgrossincome
enter this amount on Part C, Line 1 ............................
(Missouri source from Form MO-1040, Line 2) ..............................
(Missouri source from Form MO-1040, Line 4) ..............................
U. MISSOURI INCOME (Missouri sources) Line R plus Line S, less
Line T. Enter this amount on Part C, Line 1.................................
Yourself or
One Income Filer
Spouse (On A
Combined Return)
Missouri Sources Missouri Sources
Federal Form
1040 or Federal
Form 1040-SR
Line No.
.
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Part C
Missouri Income Percentage
1. Missouri Income - Enter wages, salaries, etc. from Missouri. (You must
leaMissourireturniftheamountonthislineismorethan$600) ........
2. Taxpayer’s total adjusted gross income (from Form MO-1040, Lines 5Y
and 5S or from your federal form if you are a military nonresident and you
arenotrequiredtoleaMissourireturn) ............................
3. Missouri Income Percentage - Divide Line 1 by Line 2. If greater than
100%, enter 100%. (Round to a whole percent such as 91% instead of
90.5% and 90% instead of 90.4%. However, if percentage is less than
0.5%, use the exact percentage.) Enter percentage here and on Form
3Y %
Yourself or
One Income Filer
Spouse
(On A Combined Return)
Signature
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and believe it is true, correct, and complete.
Declaration of preparer (other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo,
apenaltyofupto$500shallbeimposedonanyindividualwhofilesafrivolousreturn.
Signature
Date (MM/DD/YY)
Spouse’s Signature (if filing combined, BOTH must sign)
Date (MM/DD/YY)
1S
00
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1Y
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2S
00
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2Y
00
.
MO-1040, Lines 28Y and 28S ....................................
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3S %
MO-NRI Page 2
Instructions - MO-NRI, Part A
Part A, Line 1: Nonresidents of Missouri
If you are a Missouri nonresident and had Missouri source income, complete Part A, Line 1, Part B, and Part C. Attach a copy of
your federal return, Form(s) W-2 and 1099 and this form to your Missouri return.
Part A, Line 2: Part-Year Resident
If you were a Missouri part-year resident with Missouri source income and income from another state, you may use Form MO-NRI
or Form MO-CR, whichever is to your benefit. When using Form MO-NRI, complete Part A, Line 2, Part B, and Part C. Missouri
source income includes any income (pensions, annuities, etc.) that you received while living in Missouri. Attach a copy of your
federal return, Form(s) W-2 and 1099 and this form to your Missouri return.
Part A, Line 3: Military Nonresident Tax Status
Missouri Home of Record - If you have a Missouri home of record and you:
a) Did not have any Missouri income other than military income, were not in Missouri for more than 30 days, did not maintain a
home in Missouri during the year, but did maintain living quarters elsewhere, you qualify as a nonresident for tax purposes.
Complete Part A, Line 3 and enter “0” on Part C, Line 1.
b) Did have Missouri income other than military income, were in Missouri for more than 30 days or maintained a home in
Missouri during the year, you cannot use this form. You must file Form MO-1040 because 100 percent of your income is
taxable, including your military income. Do not complete this form.
c) Did not have Missouri income other than military income but spent more than 30 days in Missouri or maintained a home in
Missouri during the year, you must file Form MO-1040 because 100 percent of your income is taxable, including your military
income. Do not complete this form.
d) Are married to a Missouri resident, who is not in the military, but lives with you outside of Missouri on military orders, you may
use Form MO-NRI to calculate your Missouri income percentage. However, any income earned by your spouse is taxable to
Missouri. Your spouse is not eligible to complete Form MO-NRI.
Military Nonresident Stationed in Missouri - If you are a military nonresident, stationed in Missouri and you:
a) Earned non-military income while in Missouri - You must file Form MO-1040. Complete Part A, Line 3, Part B and Part C.
The nonresident military pay should be subtracted from your federal adjusted gross income using Form MO-A, Part 1, Line
10, as a “Military (nonresident) Subtraction”.
b) Only had military income while in Missouri - You may complete a Military - No Return Required Form online at
https://sa.dor.mo.gov/nri/.
Note: If you file a joint federal return, you must file a combined Missouri return (regardless of whom earned the income).
Complete each column of Part B and Part C of this form. Do not combine incomes for you and your spouse.
1. Did you maintain a permanent
place of residency in Missouri?
2. Did you spend more than 30
days in Missouri?
You are a
Resident.
Did you maintain a permanent place of
residency elsewhere?
1. Did you maintain a permanent
place of residency in Missouri?
2. Did you spend more than 183
days in Missouri?
Are you domiciled* in Missouri?
NO
YES
NO
to
both
YES
to
either
You are a
Nonresident
(for tax
purposes).
You are a Resident.
You are a
Nonresident.
You are a
Resident.
NO to either
YES
to
both
NO
YES
Use this diagram to determine if you or your spouse are a RESIDENT OR NONRESIDENT
*Domicile (Home of Record) - The place an individual intends to be his or her permanent home; a place that he or she intends to return whenever absent.
A domicile, once established, continues until the individual moves to a new location with the true intention of making his or her permanent home there.
An individual can only have one domicile at a time.
MO-NRI Page 3