Fillable Form 2879 - Irrevocable Letter Of Credit Form - State Of Missouri printable pdf download

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Missouri Department of Revenue

Form

(MM/DD/YY)

2879

Irrevocable Letter of Credit

Please print on white paper only

Missouri Tax I.D.

Federal Employer

Number

I.D. Number

(Optional)

Sales and Use Tax

Cigarette Tax

Motor Fuel Tax

Other Tobacco Products

Transient Employer Withholding and Unemployment Tax

Amount (U.S. Currency)

Letter of Credit Number

Date of Issuance (MM/DD/YYYY)

__ __ / __ __ / __ __ __ __

At the request of Taxpayer or Business (Owner’s name), all Partners, Corporation, or LLC Name

Taxpayer or Business Owner’s Address

City

County

State

Zip Code

E-mail Address

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( I s s u e r )

hereby issues this Irrevocable Letter of Credit (ILC) in favor of the Missouri Department of Revenue, in the aggregated sum of

________________________________________________________________________________________________ dollars

($__________________________). This ILC shall secure the payment of the above indicated tax and related fees, interest,

additions to tax, and penalties due the state of Missouri on or after the date this ILC is issued.

The funds shall be paid to the Department upon a written demand for payment on the Issuer referencing this ILC. A demand for any

payment shall be sent by U.S. mail or personal service. The Issuer shall upon receipt honor all partial or full demands for payment

and make payment to the Department within thirty (30) days of receipt of the demand.

This ILC shall be effective for a period of one year from the date of issuance and shall automatically renew for additional one-year

periods unless at least sixty (60) days prior to any such expiration date the Issuer notifies the Department in writing at the address

indicated for each type of tax shown above that it does not elect to renew this ILC. Any election not to renew the ILC shall not

operate to relieve, release or discharge the Issuer from any liability for the indicated tax or taxes and related fees, interest, additions

to tax, and penalties of the taxpayer or business that may accrue for all periods prior to the cancellation of the ILC.

The Department shall have a period of one year after the expiration date of the ILC to make a demand for payment upon the Issuer.

The Issuer affirms that any demand for payment made by the Department in accordance with the terms of this ILC shall be honored

upon receipt.

This agreement and any legal action pertaining thereto shall be governed by and construed in accordance with these terms and the

laws of the State of Missouri. The parties understand and agree that the exclusive jurisdiction for any action concerning this ILC shall

be the state of Missouri and the only venue shall be in the Circuit Court of Cole County, Missouri. The Issuer understands and agrees

that it shall be liable for prejudgment interest and attorney fees if it breaches its obligations under this ILC.

The person signing this ILC states that he or she has the legal authority to enter into this ILC and to legally bind the taxpayer or

business below.

No digital signatures allowed

Issuing Bank or Financial Institution

Address

City, State, Zip Code

Telephone Number

(

)

___ ___ ___

___ ___ ___ ___

Signature and Title of Bank or Financial Institution Official

Bank Official’s Typed or Printed Name

*14608010001*

14608010001

Form 2879 - Irrevocable Letter Of Credit Form - State Of Missouri

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