Form 53u-1 - Use Tax Return - 2014
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MISSOURI TAX I.D. NUMBER
FEDERAL I.D. NUMBER
RETE
RETE
MISSOURI DEPARTMENT OF REVENUE
FORM
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
TAXATION DIVISION
53U-1
P.O. BOX 840
• DO NOT WRITE IN SHADED AREAS
JEFFERSON CITY, MO 65105-0840
(573) 751-2836
(REV. 06-2014)
CLICK HERE
USE TAX RETURN
TTY (800) 735-2966
Check box if Amended Return
Or Additional Return
for instructions to complete this form.
OWNER’S NAME
REPORTING PERIOD
ADDRESS CORRECTION
MAILING ADDRESS
REPORTING LOCATION
BUSINESS NAME
Check here if
BUSINESS PHONE NUMBER:
phone # changed
(__ __ __) __ __ __ - __ __ __ __
MAILING ADDRESS
PHONE NUMBER
(__ __ __) __ __ __ - __ __ __ __
CITY
STATE
ZIP
DUE DATE:
__ __ __ __ __
VENDOR’S USE TAX
ADJUSTMENTS
GROSS RECEIPTS
TAXABLE SALES
RATE (%)
AMOUNT OF TAX
(INDICATE + OR —)
1.
VENDOR’S TOTALS (ALL PAGES) .........................
If there are no Vendor’s Sales or Consumer’s Taxable
2.
SUBTRACT: 2% TIMELY PAYMENT ALLOWANCE (IF APPLICABLE) ............................
–
Purchases for a specified location, enter zero (0). If the
location is left blank, this will be recognized as zero (0) Sales
3.
VENDOR’S USE TAX DUE .........................................................................................
and/or Taxable Purchases.
=
CONSUMER’S USE TAX
LOCATION
CODE
TAXABLE PURCHASES
RATE (%)
AMOUNT OF TAX
4.
PAGE 1 CONSUMER’S TOTALS ..............................
5.
PAGES 2 CONSUMER’S TOTALS ..........................
6.
+
CONSUMER’S TOTALS (ALL PAGES) ....................
I do not have cumulative taxable purchases totaling more than $2,000 this calendar year and do not owe Consumer’s Use Tax at this time.
TOTAL OF VENDOR’S GROSS RECEIPTS AND CONSUMER’S TAXABLE PURCHASES ....
7.
Instructions are updated annually and are provided on our web site at
8.
TOTAL USE TAX DUE ............................
=
FINAL RETURN: If this is your final return, enter the close date below and check the reason for closing your account.
Missouri law requires any person selling or discontinuing business to make a final use tax return within fifteen
9.
ADD: INTEREST FOR LATE
(15) days of the sale or closing.
+
PAYMENT (See Line 9 of Instructions) ...
Date Business Closed: ___________________________
10.
ADD: ADDITIONS TO TAX
Out of Business
Sold Business
Leased Business
(See Instructions) ................................... .
+
If you pay by check, you authorize the Department of Revenue to process the check electronically.
Any check returned unpaid may be presented again electronically.
11.
SUBTRACT: APPROVED CREDIT .........
–
SIGN AND DATE RETURN: This must be signed and dated by the taxpayer or by the taxpayer’s authorized agent.
Mail to: Missouri Department of Revenue, P.O. Box 840, Jefferson City, MO 65105‑0840.
12.
PAY THIS AMOUNT ..........................
=
I have direct control, supervision, or responsibility for filing this return and payment of the tax due. Under penalties of
perjury, I declare that this is a true, accurate, and complete return.
I ATTEST THAT I HAVE NO GROSS RECEIPTS TO REPORT FOR LOCATIONS LEFT BLANK.
I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law
and that I am not eligible for any tax exemption, credit or abatement if I employ such aliens.
SIGNATURE OF TAXPAYER OR AGENT
TITLE
TAX PERIOD (MMDDYYYY) THRU (MMDDYYYY) DATE SIGNED
_ _ / _ _ / _ _ _ _ – _ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
MO 860-1124 (06-2014)
DOR-53U-1 (06-2014)
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