Use this form to certify monthly collections to the Director of Revenue. If collector fails to file his or her monthly statements with the county clerk, the county clerk should notify the Director of Revenue and the Prosecuting Attorney.
Land Tax, 2020 $ $ $
Personal Tax, 2020
License Collection
Utility
Railroad
Payment in Lieu of Taxes
Protest
Sur Tax
Total Current Collections
TotalInterestTax
Cur
rent
Tax
es a
nd L
icen
ses
Land, 2019 $ $ $
Land, 2018
Land, 2017
Land, 2016
Land, 2015
Land, 2014
Total Back Land
Tax Interest Total
Bac
k Ta
x C
olle
ctio
ns
Gross collections must be reported in all cases.
Grand Total Collections $ $ $
Personal, 2019 $ $ $
Personal, 2018
Personal, 2017
Personal, 2016
Personal, 2015
Personal, 2014
Total Back Personal
Tax Interest Total
$ $ $
Total Back Tax Collections
Tax Interest Total
Name (Clerk of the County Commission) County Month Year
The aforementioned clerk hereby certifies to the Director of Revenue that from the monthly statement filed in their office that they have collected for state purposes the following amounts:
, Missouri
Done at my Office in
This
Cou
nty
Cle
rk
Witness my hand and official seal
Day of 20
Clerk of the County Commission
Mail to: Taxation Division Phone: (573) 751-5900 P.O. Box 453 TTY: 1-800-735-2966 Jefferson City, MO 65105-0453 Fax: (573) 522-1720
Visit dor.mo.gov/business/citycounty/for additional information.
Form 1315A (Revised 12-2019)
Form
1315A Monthly Statement of Collections
I, , C
lerk
of t
he C
ount
y C
omm
issi
on w
ithin
and
for t
he C
ount
y of
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__he
reby
cer
tify
to t
he D
irect
or o
f R
even
ue,
that
fro
m t
he m
onth
ly s
tate
men
ts f
iled
in m
y of
fice,
and
sw
orn
to b
y th
e se
vera
l Tow
nshi
p C
olle
ctor
s of
sai
d C
ount
y, it
app
ears
tha
t th
ey
have
col
lect
ed fo
r Sta
te p
urpo
ses
durin
g th
e m
onth
of
, 20
, the
follo
win
g am
ount
s, v
iz:
Mad
e by
Col
lect
or o
f
C
ount
yD
urin
g th
e m
onth
of
, 2
0
Form
131
5A (R
evis
ed 1
2-20
19)
Sta
tem
ent
of C
olle
ctio
nsM
isso
uri D
epar
tmen
t of R
even
ueM
onth
ly S
tate
men
t of T
owns
hip
Col
lect
ions
Col
lect
orIn
tere
st$
$ $
, Mis
sour
i
Don
e at
my
Offi
ce in
This
County Clerk
Witn
ess
my
hand
and
offi
cial
sea
l
D
ay o
f
20
Cle
rk o
f the
Cou
nty
Com
mis
sion