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Get Form 5131 - Cigarette Tax Ach Transfer Agreement - Missouri ...

T of Revenue City/County Tax Code (DOR USE ONLY): TYPE OF AGREEMENT (CHECK ONE): NEW CHANGE CANCEL CITY/COUNTY NAME CITY/COUNTY ADDRESS Please complete this form and return to the Missouri Department of Revenue, Administration Division, Investment and Cash Management Section, P.O. Box 87, Jefferson City, Missouri 65105-0087. Please call (573) 522-5628 with any questions concerning this form. The agreement must be received by the Department on or before the fifteenth (15th) day of the month.

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