Form 89-140-22-8-1-000 (Rev. 10/22)
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                                                                  Mississippi 
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                                                          Annual Information Return
        891402281000
                                                                  Tax Year

 FEIN                                                                                                        MS Account ID

 Name
                                                                                                            FORM TYPE
                                                                                                                        (CHECK ONE)
 Address
                                                                                               W-2                                   1099-R     

 City                                          State       Zip                                 W-2C                                  Other 1099  

 Number of Forms                                           MS Taxable Wages                                  MS Tax Withheld        MS Tax Remitted

 Signature                                                 Phone + Extension                                 Date Signed

 Submitting Company (If different than above)             Submitting Company Phone + Extension               Date Mailed

 Contact Person (Please Print)                             Address

  GENERAL INSTRUCTIONS
Employers that issue 25 or more W-2s, 1099s or other information returns are required to electronically submit those in the required formats    
to the Department of Revenue (DOR) through Taxpayer Access Point (TAP).   
. W-2s must be submitted in Social Security Administration (SSA) format and must contain the “RS” record for state data. See SSA Publication
      EFW2 for record format and specifications.
. 1099s, W-2Gs and all other information returns must be submitted in Internal Revenue Service (IRS) format.  See IRS Publication 1220  for 
      specifications and procedures.   

. You may be subject to penalties if you issue more than 25 returns and do not file as required.  All employers, regardless of the number of returns,   
      are encouraged to utilize the system to electronically enter and submit return information securely to DOR.  To access TAP and submit returns   
      electronically, visit our website at www.dor.ms.gov.

  FILING DUE DATES
* If the due date falls on a weekend or state holiday, the filing due date is the next business working day.
                 FORM TYPES                                       MEDIA                                                      * DUE DATE
                                                                  Paper and Electronic 
                 W-2s                                     Due to Employees and MDOR                                          January 31st
                                                                  Paper and Electronic
                 1099s                                    Due to Recipients and MDOR                                         February 28th

   RETURN INSTRUCTIONS
. Income reported on 1099 forms should be entered in the MS Taxable Wages box above.
. If Mississippi Tax Withheld and Mississippi Tax Remitted are not the same amount, an amended return must be filed. 
. Do not send a tax payment with this form. Credit will not be applied to your account if payment is submitted with this form. Additional 
      payments can be filed through TAP or with a paper Form 89-105, Withholding Tax Return.
. A separate Form 89-140 must be submitted for each type of return. This form is not filed with electronic returns, but must be filed 
      with paper returns. Mail the form and copies of information returns to:  

                                                          Department of Revenue   
                                                          Withholding Tax Division   
                                                                  P.O. Box 23058 
                                                           Jackson, MS 39225-3058