MO-PTENR — Pass-Through Entity Nonresident Schedule

Form
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Department Use Only
(MM/DD/YY)
2025 Nonresident Member Opt-Out of Pass-Through

Entity Income Tax
For calendar year Jan. 1 - Dec. 31, 2025, or fiscal year r Partnership r S Corporation
Federal Employer

Part 1 - Name and
I.D. Number
Business

Address
Name
Street

Address
City State
Member

Name
Federal Employer
I.D. Number
Street
Address
25126010001
Beginning Ending
(MM/DD/YY) (MM/DD/YY)
Missouri Tax
I.D. Number
Email
ZIP
Social Security
Number
Missouri Tax
I.D. Number
City State ZIP
I, __, as a partner or shareholder of the above-named partnership or S corporation, elect not to have tax imposed on the partnership or S corporation with respect to its separately and nonseparately computed items Part 2 - Opt-Out Election described in subsections 3 or 4 of Section 143.436, RSMo, as the case may be, and otherwise subject to pass-through entity income tax, to the extent such items are allocable to me. This election applies for the partnership's or S corporation's tax year 2025 and all subsequent tax years. By making this election and signing below, I agree to, for my tax year corresponding to the partnership or S corporation's 2025 tax year, and all subsequent tax years:

1. File an income tax return in accordance with the provisions of Section 143.481, RSMo, and make timely payment of all taxes imposed on me by this state with respect to the income of the affected business entity; and
2. Be subject to personal jurisdiction in Missouri for the purpose of the collection of income taxes, together with related interest and penalties, imposed on me by Missouri with respect to the income of the affected business entity.

Member

# Part 3 - Revocation of Opt-Out Electton

Name
Federal Employer
I.D. Number
Street

Address
City State
Social Security
Number
Missouri Tax
I.D. Number
ZIP
I, _, as a partner or shareholder of the above named partnership or S corporation, do hereby revoke my previous pass-through entity income tax opt-out election dated _ / _ _ / _ _ _ _ not to have tax imposed on the partnership or S corporation with respect to its separately and nonseparately computed items described in subsections 3 or 4 of section 143.436, RSMo, as the case may be, and otherwise subject to pass-through entity income tax, to the extent such items are allocable to me. This revocation applies for the partnership's or S corporation's tax year

2025 and all subsequent tax years.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

# Part 4 - Signature

Signature of Member
Telephone
Number
Mail to: Taxation Division
Printed
Name
Date Signed
(MM/DD/YY)
E-mail: pteincome@dor.mo.gov
P.O. Box 3080
Visit dor.mo.gov/faq/taxation/business/entity-tax.html/ or additional information.
Jefferson City, MO 65105-3080
Ever served on active duty in the United States Armed Forces?

If yes, visit dor.mo.gov/military/ to see the services and benefits DOR offers to all eligible military individuals, or Phone: (573) 751-4541 complete the survey at mvc.dps.mo.gov/MoVeteransInformation/Survey/DOR to receive information from the
Fax: (573) 522-1721
Missouri Veterans Commission. A list of all state agency resources and benefits can be found at v eteranbenefits.mo.gov/state-benefits/.

24000000001
Information to Complete Form MO-PTENR
The Form MO-PTENR is used to enter into an agreement between the nonresident partner or S corporation shareholder and the Missouri Department of Revenue (Department) for an election affecting the pass-through entity tax computation of the partnership or S corporation with respect to which this form is filed. This election is provided for, and further described, under Subsection 5 of Section 143.436, RSMo. For special definitions of terms used in this document, such as partnership or affected business entity, please see the Form MO-PTE Instructions.
Where and When to File
This agreement will be considered timely filed for a partnership's or S corporation's tax year, and all subsequent tax years, if it is filed at or before the time the Form MO-PTE for that tax year is required to be filed (without regard to any extension to file the Form MO-PTE), or the actual filing date of the Form MO-PTE for that tax year, whichever occurs first. Mail the completed Form MO-PTENR(s) to the address at the bottom of the form. Provide a copy to the affected business entity to be included with the Missouri pass-through entity income tax return.

# Part 1 - Name and Address

Part 1 is completed by the partnership or S corporation.
Select the partnership or S corporation box at the top of the form. Enter the partnership's or S corporation's federal identification number, Missouri identification number (if applicable), the business name, email address, street address, city, state, and ZIP code in the spaces provided.

# Part 2 - Opt-Out Election

Part 2 is completed by the nonresident member electing to not have pass-through entity income tax imposed on the partnership or S corporation with respect to separately and nonseparately computed items allocable to that member. Enter member's name, social security number, FEIN, or Missouri tax identification number (if applicable), and street address, city, state, and ZIP code in the spaces provided. By making this election, you are also agreeing:

1. To file an income tax return in accordance with the provisions of Section 143.481, RSMo and to make timely payment of all taxes imposed on you by Missouri with respect to the income of the affected business entity, for your tax year that corresponds to the affected business entity's tax year 2025, as well as for all subsequent tax years; and
2. To be subject to personal jurisdiction in Missouri for the purpose of the collection of income taxes, together with related interest and penalties, imposed on you by Missouri with respect to the income of the affected business entity for your tax year that corresponds to the affected business entity's tax year 2025, as well as for all subsequent tax years.

# Part 3 - Revocation of Opt-Out Election

Part 3 is completed by the nonresident member electing to revoke the opt-out election. Once an opt-out election is filed, it applies to the tax year for which it was first timely filed and for all subsequent tax years. However, an opt-out member may revoke that member's opt-out election. To be effective for a tax year, the revocation must be filed with the department by the filing due date of an opt-out election for that tax year. The member shall also furnish the opt-out election revocation to the partnership or S corporation. The revocation of an opt-out election applies to the tax year for which the revocation was first timely filed, and for all subsequent tax years, until a new opt-out election is filed.

# Part 4 - Signature

You must sign and date your agreement. Please include a daytime telephone number where you may be reached in case the

Department has questions regarding your agreement.
Federal Privacy Act Notice
Section 143.961, RSMo, authorizes the Department to require the reporting of information deemed necessary to enforce the income tax law of the state of Missouri. Section 405(c)(2)(C) authorizes the states to require taxpayers to provide social security numbers. The Department uses your social security number to identify you and process your tax returns and other documents, to determine and collect the correct amount of tax, to ensure you are complying with the tax laws, and where permitted or required by law, to exchange tax information with the Internal Revenue Service, other states, other state agencies, and the Multistate Tax Commission (see Chapters 32, 143, and 610, RSMo). It is mandatory that you provide your social security number on this form. Failure to provide your social security number may result in additional request(s) to you from the Department. (For further information about the Department's authority to prescribe forms and to require furnishing of social security numbers, see Chapters 143, RSMo.)