Fillable SBGFP CBI Clearance Form Fillable (City of St. Louis)

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SBGFP CBI Clearance Form Fillable (City of St. Louis)

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The SBGFP CBI Clearance Form Fillable (City of St. Louis) form is 1 page long and contains:

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  • 19 check-boxes
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Country of origin: US
File type: PDF

U.S.A. forms for City of St. Louis

BROWSE CITY OF ST. LOUIS (MO) FORMS
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SLDC Rev. 2022- Small Business Grant Program
COMPTROLLER’S OFFICE
DATE
TAX VERIFICATION FORM
TO:
COLLECTOR OF REVENUE
ROOM 410, CITY HALL
LICENSE COLLECTOR
ROOM 104, CITY HALL
FROM:
DEPARTMENT
St. Louis Development Corporation
ROOM NO./BUILDING
CITY CONTACT PERSON
SLDC Grants
CITY CONTACT PERSON EMAIL
SLDC-Grants@StLouis-MO.gov
CONTRACT INFORMATION
BUSINESS NAME
OCCUPATION/PROFESSION
BUSINESS ADDRESS
CITY
STATE
ZIP
F.I.D./S.S.N.
TELEPHONE NO.
TYPE OF CONTRACT
SALES
SERVICES
BOTH
TYPE OF PRODUCT OR SERVICE
IF SERVICE RENDERED, PERFORMANCE WILL BE
INSIDE CITY LIMITS
OUTSIDE CITY LIMITS
DOES VENDOR DELIVER PRODUCT OR MAKE SALES/SERVICE CALLS IN THE CITY?
YES
NO
COLLECTOR OF REVENUE ROOM 410, CITY HALL
LICENSE COLLECTOR ROOM 104, CITY HALL
Date Received
Date Received
TAX DELINQUENCIES
Paid
Exempt
Delinquent
Needs
License
[ ]
Earnings Tax Withholding
Year
Quarter
Manufacturer’s Tax
[ ]
Annual E-234
Year
Business License
[ ]
Payroll Expense Tax
Year
Quarter
Other
[ ]
Reconciliation Report
(W-3 Form)
Year
Remarks
[ ]
Personal Property Tax
Year
[ ]
Not on current Earnings Tax Rolls.
APPROVED BY
[ ]
Not on current Personal Property Tax Rolls.
(Please Sign)
REJECTED BY
[ ]
APPROVED
Date
By
(Please Sign)
[ ]
REJECTED
Date
By
Date
If Rejected: What department should the business owner follow up with? (Please check all that apply below)
Assessor’s Office (1200 Market St., Room 120 –
314.622.4050)
Building Division (1200 Market St., Room 426 –
314.622.3313)
Collector of Revenue (1200 Market St., Room 110 –
314.622.4111)
License Collector’s Office (1200 Market St., Room 104 –
314.622.4528)
Health Department (1520 Market St., Room 4051 –
314.612.5100)
State Office (https://dor.mo.gov/)
Other (please specify) ____________________________
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SBGFP CBI Clearance Form Fillable (City of St. Louis)

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Completed 13 April 2022

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