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                                                               Mississippi                                Print Form
Form 89-386-22-8-1-000 (Rev.10/22)  Affidavit for Withholding Income Tax
                                                on Sale of Real Estate by
                                                             Non-Resident
                                                                              , duly swears under penalty of perjury the following facts:
                                   Seller's Name

1. Seller's Name and Address
                                                                              Address

                                                        City                              State           Zip

2. Description, location and tax map parcel number of property sold

3. Buyer's Name and Address
                                                                              Buyer's Name

                                                                    Address

                                                City                                      State           Zip

4. The total sales price is                                                   Closing date

5. The gain to be reported on the seller's MS Income Tax Return
   (From Page 2, Schedule A, Line 5)
6. Income tax at 5% of the gain (Line 5 multiply by 5%)

7. The net proceeds payable to the seller (From Page 2, Schedule B, Line 5)

8. Income tax amount required to be withheld . (Enter the smaller of line 6 or
   line 7)

9. The seller will file all state Income Tax Returns due

Witness my signature, this the                               Day of                                       , 20

          Social Security Number                                    State of

   Social Security Number or ID Number of Spouse                    County of
          Seller's Signature                                        This  day  personally  appeared  before  me,  the  undersigned  authority  of  law  in
                                                                    and for said county and state, the above signed seller who acknowledges that he
                                                                    signed  and  delivered  this  affidavit  on  the  day  and  year  and  for  the  purposes
                                                                    mentioned therein.
          Signature of Spouse                                       Given under my hand and seal, this the
                                                                              Day of      , 20

   Mail To: MS Department of Revenue                                My Commission Expires
              P.O. Box 23050
           Jackson, MS 39225-3050
                                                                                          Notary Public

                                                                                                      Page 2
                                                      Mississippi
Form 89-386-22-8-2-000 (Rev.10/22) Affidavit for Withholding Income Tax
                                         on Sale of Real Estate by
                                                      Non-Resident

Only  mortgages  and  liens  on  the  property  being  sold  may  be  deducted  from  the  sales  price.  Mortgages,  liens  or
advances  on  credit  lines  in  contemplation  of  the  sale  cannot  be  deducted  unless,  the  buyer  can  presume  that  any
mortgage, lien or credit lines made more than one year before the closing are not in contemplation of the sale and may
be deducted. If the mortgage, lien or credit line advance is made less than one year prior to the closing, the buyer cannot
deduct the mortgage, lien or credit line advance unless the buyer obtains an affidavit from the seller, which states that the
loan  or  advance  was  not  made  in  contemplation  of  the  sale  and  meets  the  requirements  and  includes  all  of  the
information contained in this affidavit. 

  Schedule A - Computation of Gain

1. Total sales price
2. Less selling expenses - Attorney fees
                    Real estate commission
                    Termite, heating & air letter fees
                    Other - list

3. Net sales price (Line 1 minus Line 2)
4. Less tax basis
5. Gain for tax purposes (Line 3 minus Line 4, enter here and on Page 1, Line 5)

  Schedule B - Computation of Net Proceeds

1. Total sales price
2. Less selling expenses - Attorney fees
                    Real estate commission
                    Termite, heating & air letter fees
                    Other - List

3. Net sales price (Line 1 minus Line 2)
4. Less mortgages, liens or advances on credit lines not made in contemplation of the sale (see above)
5. Net proceeds payable to the seller (Line 3 minus Line 4, enter here and on Page 1, Line 7)