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Form v Missouri Department of Revenue

53-1 C Sales Tax Return RETE

Select one if: Missouri Tax Identification Number Federal Employer Identification Number
Amended Return L~J Additional Return
Owner Name Business Name Reporting Period
Jonathan Sessions Percussive Repair LLC 201512
Mailing Address City State Zip Code
115 Aldeah Ave Columbia MO 65203
Business Phone Number Due Date E-mail Address
(J__L)i_J_-Xi_J_l 0 2/01/2016

Address Correction: CJ Mailing Address HJ Reporting Location Department

Use Only

This return must be filed for the reporting period indicated even if you haye no gross receipts or tax to report.
Gross Adjustments Rate (%) Amount of Tax
Business Location Code Taxable Sales
Receipts (Indicate + or -)
115 Aldeah Ave 15670 019
0001 \ $99.99 7.975 $7.97
' m

Page 1 Totals <r9 ML QQ QQ $7.97

Page - To t a l s .
Totals (All Pages) *M Ba S99.99 1 $7.97

Subtract: 2% timely pa yment 2.

to file your sales tax return electronically. allowance (if applicabl e)
Final Return: If this is your final return, enter the close date below and check
the reason for closing your account. Missouri law requires any person selling
or discontinuing business to make a final sales tax return within fifteen (15) Add: interest for late payments 4.
(See Line 4 of Instructions) +
days of the sale or closing.
Date Business Closed (MM/DD/YYYY): 0 6/3 0/2 0 1 6 +
Add: additions to tax
ID Out of Business d Sold Business d Leased Business 6.
Subtract: approved credit
Visit to determine if
you have a credit for which you may be entitled to a refund. Pay this amount
(U.S. Funds only) *" 1 $7.97
If you pay by check, you authorize the Department of Revenue to process the check
electronically. Any check returned unpaid may be presented again electronically. Department Use Only
Under penalties of perjury. I declare that the above information and any attached supplement is true, complete, and correct. I have direct control,
supervisiojvr responsibility fo^fffingihis return and payment of the tax due. I attest that I have no gross receipts to report for locations left blank.
Title Date (MM/DD/YYYY)
Owner 0 7/18/20 16
Tinted Name Tax Period (MM/DD/YYYY) though (MM/DD/YYYY)
Jonathan Sessions 0_ _L /0_ J_ /2_ fj_ _i_ Ji through _L A /_3_ _1 /2_ A A _5
Form 53-1 (Revised 06-2014)
Mall to: Taxation Division Phone: (573) 751-2836
P.O. Box 840 TTY: (800) 735-2966 http://dpr,mo-qQV/frMgiPeg8/ga,l9S/ Hy&ft H
Jefferson City, MO 65105-0840 for additional information. i^S?5iJ5
Fax: (573) 526-8747
Missouri: Department of Revenue
7/18/2016- 2:33:39 PM (CT)

name Percussive Repair LLC

confirmation number 32270983

effective date 07/18/2016

payment method eCheck

account number

payment amount $7.97

convenience fee amount $0-50
total remitted $8-47

Sales/Use Tax Return Payment

(19711751, 2016, 12, 1, 0, 0, 0, 0, $0.00, $0.00) - $7.97

The charge will show on your account as :


This receipt reflects your authorization for

CollectorSolutions, Inc. ("CSI") to initiate an ACH debit
entry to the above designated bank account for the Total
Remitted specified. In the event CSI is unable to secure
the funds for this .transaction from your account for any
reason, including but not limited to insufficient funds in your
account or insufficient or inaccurate information, further
collection action may be undertaken by CSI including any
application of returned check fees to the extent permitted
by law.