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Form Tax Year
MO-96 Annual Summary and Transmittal of Missouri Forms MO-99 Misc.
20_____
Enter the total number of Federal 1099-MISC forms if substituted for the Missouri Form MO-99 Misc. ___________________
All documents are: r Original r Corrected r With Taxpayer Identifying No. r Without Taxpayer Identifying No.
Name Identifying Number
Address City State ZIP Code
Under penalties of perjury, I declare that the information I have provided is true, complete, and correct. I have direct control, supervision or
responsibility for filing this return. In the case of documents without recipients’ identifying numbers I have complied with the requirements of the
law by requesting such numbers from the recipients, but did not receive them.
Payer’s Information Signature Title Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Form MO-96 (Revised 11-2020)
Mail to: Taxation Division Phone: (573) 751-3505
P.O. Box 3330 Fax: (573) 522-1762 Visit dor.mo.gov/taxation/individual/tax-types/income/
Jefferson City, MO 65105-3330 E-mail: income@dor.mo.gov for additional information.
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