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

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Form

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