Form MO-3NR Fillable Partnership / S Corporation Withholding Exemption / Revocation Agreement
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

| | | | | | | | | | | | | | | | | | | | | | E mail: income@dor mo gov Jefferson City MO 65105 3815 Fax: (573) 526 7939 P O Box 3815 TDD: (800) 735 2966 ( ) / / (1) To file a return in accordance with the provisions of (2) To be subject to personal jurisdiction in this state for (Completed by the partnership or S corporation) (Completed by the taxpayer electing exemption from (Completed by the taxpayer electing to revoke the | | | | | | | | 1) File an individual income tax return in accordance with the provisions of Section 143 481 RSMo and make timely payment 143 481 RSMo and to make timely payment 2) Be subject to personal jurisdiction in this state for the purpose of the collection of income taxes together with Additionally the Form MO 3NR can be used to revoke a previous Address also agreeing to the following: and for all subsequent taxable years if it is filed at or before the bottom of the form Business Name Street Address By signing this agreement I agree to: City State Zip Code E mail Address corporation do hereby revoke my previous withholding election dated / / At this time I corporation until you notify the Department of a change Daytime Telephone Date (MM/DD/YYYY) Department Use Only daytime telephone number where you may be reached in case Department of a change in this election Department Use Only distributive share item(s) of partnership or S corporation income election of exempt withholding status Enter your name social security number and address in the exempt status from Missouri income tax withholding on Missouri exempt status) Exemption or Revocation Agreement Exemption Revocation Federal Employer Identification Number Missouri Tax Identification Number filed without regard to extension of time to file filing a new Form MO 3NR for additional information For calendar year Jan 1 Dec 31 or fiscal year beginning and ending Form MO 3NR (Revised 12 2013) Form MO 3NR Instructions I as a partner or shareholder of the above named partnership or S I as a partner or shareholder of the above named partnership or S corporation I maintain my exemption status; and in this election; income of this partnership or S corporation income taxes on your Missouri distributive share item(s) and to Mail the completed Form MO 3NR(s) to the address at the Mail to: Taxation Division Phone: (573) 751 3505 Missouri Department of Revenue Missouri Department of Revenue (Department) for an election of Missouri identification number name address and e mail MO 3NR Name and Address Note: If you are electing to revoke your withholding exemption of all taxes imposed on me by this state with respect to the income of the partnership or S corporation for every year in which of all taxes imposed on you by the state of Missouri or S corporation for the tax year and all subsequent tax years until I notify the Department of a change in this election Part 1 Part 1 Name and Part 2 Part 2 Withholding Tax Exemption Part 3 Part 3 Withholding Tax Part 4 partnership or S corporation partnership or S corporation is required to withhold Missouri Partnership or S Corporation Withholding Partnership or S Corporation Withholding Exemption or Revocation Agreement Parts 1 3 and 4 only r Partnership r S Corporation r Revocation Indicator related interest and penalties imposed on me by this state with respect to my distributive share of the income for this remain in effect until you elect to change your exempt status by remit this withholding tax on your behalf The revocation will request to be exempt from Missouri income tax withholding on my Missouri distributive share item(s) received through this partnership request to be subject to withholding by this partnership or S corporation on my Missouri distributive share item(s) received Section Select partnership or S corporation in the spaces provided enter Signature Signature of Taxpayer Printed Name spaces provided By requesting an exemption from Missouri spaces provided By revoking your exemption status the status please check the box at the top of the form and complete Street Address City State Zip Code Taxpayer Name Social Security Number the Department has questions regarding your agreement The Form MO 3NR is used to initiate an agreement between the nonresident partner or S corporation shareholder and the the partnership or S corporation federal identification number the purpose of the collection of income taxes together This agreement will be considered timely filed for a taxable year this state with respect to your distributive share of the through this partnership or S corporation for the tax year and all subsequent tax years until I notify the time the annual return for such taxable year is required to be Under penalties of perjury I declare that the above information and any attached supplement is true complete and correct Visit http://dor mo gov/business/partner When to File Where to File with related interest and penalties imposed on you by with respect to the income of the partnership or S withholding on your Missouri distributive share item(s) you are Withholding Tax Exemption Withholding Tax Exemption Revocation withholding) You must sign and date your agreement Please include a