Fillable Printable Form 4379B - Missouri Department Of Revenue

Form 4379B - Missouri Department Of Revenue

Agency

Information

City State ZIP Code

Address

Name

Pursuant to provisions of Section 144.083, RSMo, the possession of a statement from the Department of Revenue stating no tax is due under Sections

143.191 to 143.265, RSMo, (withholding tax) or Sections 144.010 to 144.510, RSMo, (sales tax) shall be prerequisite to the issuance or renewal of any

state license required for conducting any business where goods are sold at retail. Through online access to MyTax Missouri portal, a state agency may

determine if a business has “no tax due” without requiring a certificate to be issued by the Department. The information obtained from the online system

is strictly confidential according to Section 32.057, RSMo. Persons authorized to access taxpayer information may only do so in the performance of their

official duties.

The Department has made access to the online No Tax Due System through a secure portal, MyTax Missouri. Please log onto the MyTax Missouri portal

at https://mytax.mo.gov and sign up for access as a Government User. Each individual with the state agency listed on Form 4379B will need to register

separately on MyTax Missouri as a Government User. Each Government User will receive an e-mail with their temporary password at which time they may

log into MyTax Missouri and set up a series of security questions and make any changes to their user profile. Once you have requested access complete

the Form 4379B and submit it to the Department. We will validate the information provided on the form and grant access as requested.

To obtain access to MyTax Missouri portal and gain access to this tax information, the appropriate authorized Division Director of your agency must

complete and sign Form 4379B. You must identify each person authorized to receive the information. If the person authorized to receive this information

changes, complete a new form. If more than three persons will be authorized to receive access, please submit an attachment with the required information.

Form

4379B

Missouri Department of Revenue

State Agency License No Tax Due

Online Access Request

Form 4379B (Revised 08-2017)

Mail to: Taxation Division Phone: (573) 751-9268

P.O. Box 3666 Fax: (573) 522-1265

Jefferson City, MO 65105-3666 E-mail: [email protected]

Visit http://www.dor.mo.gov/business/sales/notaxdue for additional information.

Name Title Effective Date (MM/DD/YYYY)

E-mail Address User ID

Name Title Effective Date (MM/DD/YYYY)

E-mail Address User ID

Name Title Effective Date (MM/DD/YYYY)

E-mail Address User ID

Name Title Effective Date (MM/DD/YYYY)

E-mail Address User ID

Print Name

Signature

Date (MM/DD/YYYY)

__ __ / __ __ / __ __ __ __

As the Division Director, I authorize and hereby conrm that the individual(s) named on this form and any attachments will receive and perform the

inspection or audit on behalf of the Department. We have reviewed and will comply with Section 32.057, RSMo, pertaining to the strict condentiality

of all records of the Missouri Department of Revenue to which access has been granted.

Authorization For Access

List below the individuals needing access to the MyTax Missouri portal and indicate the access needed. Each user will need to have a unique e-mail

address. Please print.

__ __ / __ __ / __ __ __ __

Signature

Title

r Online No Tax Due Access

r Compliance Report *

* Only for Department of Public Safety.

r Online No Tax Due Access

r Compliance Report *

r Online No Tax Due Access

r Compliance Report *

r Online No Tax Due Access

r Compliance Report *

*14024010001*

14024010001

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