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Any check returned unpaid may be presented again electronically. MO 860-1120 09-2010 1895 Reset Form Print Form INSTRUCTIONS FOR COMPLETING FORM MO-941 Use the correct return. 1. Interest see Instructions. DUE ON OR BEFORE 5. Additions to Tax MO-941 1. Withholding This Period. 4. Balance Due. MISSOURI DEPT. OF REVENUE FORM FEIN BUSINESS NAME OWNER S NAME MAILING ADDRESS STREET CITY STATE ZIP CODE I have direct control supervision or responsibility for filing this return and payment of the tax due. FILING FREQUENCY EMPLOYER S RETURN OF INCOME TAXES WITHHELD MO TAX ID NUMBER FOR TAX PERIOD YYYY MM 2. Compensation Deduction. 3. Previous Overpay/ Payments. 7. Total Amount Due U*S* funds only. REV. 09-2010 6. Interest see Instructions. DUE ON OR BEFORE 5. Additions to Tax MO-941 1. Withholding This Period. 4. Balance Due. MISSOURI DEPT. OF REVENUE FORM FEIN BUSINESS NAME OWNER S NAME MAILING ADDRESS STREET CITY STATE ZIP CODE I have direct control supervision or responsibility for filing this return and payment of the tax due. Under penalties of perjury I declare it is a true accurate and complete return* AUTHORIZED SIGNATURE DATE MAIL REMITTANCE AND RETURN TO Missouri Department of Revenue P. O. Box 999 Jefferson City Missouri 65108-0999. DOR USE ONLY If you pay by check you authorize the Department of Revenue to process the check electronically. Enter the amount of employer withholding tax for the period on Line 1. 2. Enter the compensation deduction for timely payment made on Line 2. 3. Enter previous overpayments/credits on Line 3. 4. Compute balance due. Subtract Lines 2 and 3 from Line 1 and enter the difference on Line 4. 5. Compute additions to tax if applicable and enter on Line 5. A. For failure to pay withholding tax by the due date subtract Line 3 from Line 1 and multiply the result by 5 percent or late not to exceed 25 percent. 6. Compute interest if applicable and enter on Line 6. Divide the annual interest rate by 365 366 for leap years to obtain the daily interest rate. Then subtract Line 3 from Line 1 and multiply the result by the daily interest rate for each day late. The annual interest rate is subject to change each year. You can access the annual interest rate on our web site at http //dor. mo. gov/intrates. php 7. Compute total amount due. Add Lines 4 5 and 6 and enter on Line 7. Mail your remittance and return to Missouri Department of Revenue P. O. Box 999 Jefferson City MO 65108-0999 payable to Missouri Director of Revenue and include your Missouri Tax I. FILING FREQUENCY EMPLOYER S RETURN OF INCOME TAXES WITHHELD MO TAX ID NUMBER FOR TAX PERIOD YYYY MM 2. Compensation Deduction. 3. Previous Overpay/ Payments. 7. Total Amount Due U*S* funds only. REV. 09-2010 6. Compensation Deduction. 3. Previous Overpay/ Payments. 7. Total Amount Due U*S* funds only. REV. 09-2010 6. Interest see Instructions. DUE ON OR BEFORE 5. Additions to Tax MO-941 1. Withholding This Period. 4. Balance Due. MISSOURI DEPT. OF REVENUE FORM FEIN BUSINESS NAME OWNER S NAME MAILING ADDRESS STREET CITY STATE ZIP CODE I have direct control supervision or responsibility for filing this return and payment of the tax due. Under penalties of perjury I declare it is a true accurate and complete return* AUTHORIZED SIGNATURE DATE MAIL REMITTANCE AND RETURN TO Missouri Department of Revenue P.

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