Fillable Printable Form 5522 - No Tax Due Request
Fillable Printable Form 5522 - No Tax Due Request
Form 5522 - No Tax Due Request
Name of
Business
Business Mailing
Address
City State Zip
Doing Business
As Name (DBA)
Contact
Person
I am required to provide a No Tax Due Certicate for the following:
Please indicate for which city or county you are requesting the No Tax Due. You must have a registered sales location in that city
or county.
OR
Reason for request (Select the appropriate box below):
City County
Business License Egg License Liquor License Fireworks License Frozen Dessert
Kennel License Lodging License Pharmacy Picnic License
If you need a No Tax Due Certicate for any other reason, you can contact the Tax Clearance Unit at (573) 751-9268. If you need
a FULL Tax Clearance, please ll out a Request for Tax Clearance (Form 943).
Person authorized to
receive this information
Title
Reason For No Tax DueAuthorization and Signature
Mail, Fax, Taxation Division Phone: (573) 751-9268
or E-mail to: P.O. Box 3666 TDD: (800) 735-2966
Jefferson City, MO 65105-3666 Fax: (573) 522-1265
E-mail: [email protected]
Visit http://dor.mo.gov/faq/business/taxclear.php for additional information.
Form 5522 (Revised 09-2014)
Form
5522
Missouri Department of Revenue
No Tax Due Request
*14028010001*
14028010001
Telephone
Number
Telephone
Number
Address City State ZIP
Signature of
Owner or Officer
Title
Printed Name of
Owner or Officer
E-mail
Address
Fax
Number
Telephone
Number
Fax
Number
E-mail
Address
Department Use Only
(MM/DD/YY)
Missouri Tax I.D.
Number
Federal Employer
I.D. Number
Social Security
Number
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