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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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