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r Limited Liability Company (Treated as a Partnership)
r Limited Liability Company (Treated as a Partnership)
2013 Statement of Income Tax Payments For
2013 Statement of Income Tax Payments For
Address Federal Employer I D Number
Address Federal Employer I D Number
Address Income Subject to Tax
Address Income Subject to Tax
Attach to Form MO 1NR See instructions for Line 1 of Form MO 1NR
City or Town State Zip Code Missouri Income Tax Payment
City or Town State Zip Code Missouri Income Tax Payment
City or Town State Zip Code Type of Entity: r Partnership r S Corporation
City or Town State Zip Code Type of Entity: r Partnership r S Corporation
Copy A
Copy B
Copy C
For calendar year 2013 or fiscal year beginning 2013 and Ending 2014
For calendar year 2013 or fiscal year beginning 2013 and Ending 2014
Form MO 2NR (Revised 11 2013)
Form MO 2NR (Revised 11 2013)
Missouri Department of Revenue
Missouri Department of Revenue
MO 2NR
MO 2NR
Name Missouri Tax I D Number
Name Missouri Tax I D Number
Name Social Security Number
Name Social Security Number
Nonresident Individual Partners or S Corporation Shareholders
Nonresident Individual Partners or S Corporation Shareholders
Partner or
Partner or
Partner or Shareholder Keep this copy for your records
Partnership or
Partnership or
Partnership or S Corporation Keep this copy for your records
S Corporation
S Corporation
Shareholder
Shareholder
Visit http://dor mo gov/ for additional information
Visit http://dor mo gov/ for additional information
