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Form 80-108-22-8-1-000 (Rev. 10/22)
                                                                                                                             Print Form
                                                                      Mississippi
                                                            Adjustments And Contributions                                                            Page 1
             801082281000
                                                                                  2022

Taxpayer Name                                                                                    SSN

 PART I:  SCHEDULE A - ITEMIZED DEDUCTIONS     (ATTACH FEDERAL FORM 1040 SCHEDULE A) 
In the event you filed using the standard deduction on your federal return and wish to itemize for Mississippi purposes, use Federal Form 1040 Schedule A as a worksheet  
and transfer the information from the specific lines indicated to this Schedule A.

1     Federal adjusted gross income from Federal Form 1040, line 11               1                 .00

2          a Medical and dental expenses                                          2a                .00
       b     Multiply line 1 by 7.5% (.075)                                       2b                .00
      c Medical and dental expense deduction (line 2a minus line 2b)                                                      2c                                  .00

3          a Total taxes paid                                                     3a                .00
       b     Less state income taxes (or other taxes in lieu of)                  3b                .00
       c     Total taxes paid deduction (line 3a minus line 3b)                                                           3c                                  .00

4     Total interest paid                                                                                                 4                                   .00
5     Charitable contributions                                                                                            5                                   .00
6     Total casualty or theft loss (attach Federal Form 4684)                                                             6                                   .00

7          a Other miscellaneous deductions                                       7a                .00
       b     Less Mississippi gambling losses                                     7b                .00
       c     Total other miscellaneous deductions (line 7a minus line 7b)                                                 7c                                  .00

8     Mississippi itemized deductions       (add lines 2c, 3c, 4, 5, 6, 7c); enter here and on Resident Form 80-105,      8                                   .00
       page 1, line 14 or Non-Resident Form 80-205, page 1, line 14a

  PART II:  SCHEDULE B - INTEREST AND DIVIDEND INCOME     (FROM FEDERAL FORM 1040, SCHEDULE B)    

1     Interest income from all sources                                                                                    1                                   .00
2     Amount of Mississippi nontaxable interest in line 1                                                                 2                                   .00
3     Total Mississippi interest (line 1 minus line 2, enter here and on Form 80-105, line 43 or Form 80-205, line 44)    3                                   .00
4     Total dividends from all sources                                                                                    4                                   .00
5     Amount of Mississippi nontaxable distributions reported in line 4                                                   5                                   .00
6     Total Mississippi dividends (line 4 minus line 5, enter here and on Form 80-105, line 44 or Form 80-205, line 45)   6                                   .00

  PART III:  VOLUNTARY CONTRIBUTION CHECK-OFFS     (RESIDENTS ONLY)
You may elect to voluntarily contribute all or part (at least $1) of your income tax refund to one or more of the funds listed below.  Refer to the instruction booklet 80-100 (may 
be downloaded from our website at www.dor.ms.gov) for an explanation of the purpose of each of these funds and how the refund donations will be used.

 Military Family Relief Fund                            .00                       Wildlife Fisheries and Parks Foundation                                  .00
 Burn Care Fund                                         .00                       Commission for Volunteer Service Fund                                    .00
 Wildlife Heritage Fund                                 . .0000
 Educational Trust Fund                                 .00

      Enter total of check-offs here and on Form 80-105, page 1, line 33                                                                                   .00

                                                            Duplex and Photocopies NOT acceptable

Form 80-108-22-8-2-000 (Rev. 10/22)
                                                       Mississippi
                                                                                                             Page 2
                                                     Adjustments And Contributions
    801082282000
                                                       2022
                                                                                                       SSN

  PART IV: INCOME (LOSS) FROM RENTS, ROYALTIES, PARTNERSHIPS, S CORPORATIONS, TRUSTS AND ESTATES

A    INCOME (LOSS) FROM RENTAL REAL ESTATE AND ROYALTIES

   1  Total rental real estate and royalty income (loss) (from Federal Schedule E, Part 1 and Part 5;  
       attach Federal Schedule E)                                                                         A1                      .00
   2  Add: depletion claimed in excess of cost basis                                                      A2                      .00
   3  Rental real estate and royalty income (loss) for Mississippi purposes (line 1 plus line 2)          A3                      .00

B    INCOME (LOSS) FROM PARTNERSHIPS, S CORPORATIONS, ESTATES AND TRUSTS 
                                              (ATTACH MISSISSIPPI K-1S AS APPLICABLE)
         COLUMN A                                                  COLUMN B                                       COLUMN C     
    NAME OF ENTITY                                     FEIN (MUST INCLUDE FEIN)                           INCOME (LOSS) MISSISSIPPI K-1S

                                                                                                                               .00
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1  Total income (loss) from partnerships, s corporations, estates and trusts (Column C)                B1                       00
                                                                                                                               .

C    Total of Section A and Section B income (loss)(line A3 plus line B1); enter here and on Form  
   80-105, line 41 or Form 80-205, line 42                                                                C                       .00

  PART V: SCHEDULE N - OTHER INCOME (LOSS) AND SUPPLEMENTAL INCOME

1  Net operating loss (enter from Form 80-155, line 2)                                                    1                       .00
2  First-time home buyer unqualified expenses                                                             2                       .00
3  Catastrophe savings taxable distribution                                                               3                       .00
List other types of income (loss)

4                                                                                                         4                       .00
5                                                                                                         5                       .00
6                                                                                                         6                       .00
7                                                                                                         7                       .00
8                                                                                                         8                       .00
9                                                                                                         9                       .00

10 Total Schedule N Other Income (Loss); enter here and on Form 80-105, page 2, line 48 or                10                      .00
   Form 80-205, page 2, line 49