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Form 80-115-22-8-1-000 (Rev. 10/22)
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                                                                    Mississippi
 MS8453-IIT                                               Individual Income Tax Declaration
                                                                                                                         Submission Number
                                                                    For Electronic Filing
                                                                        2022
Taxpayer First Name                   Initial  Last Name
                                                                                                                         YOU MUST ENTER SSN
Spouse First Name                     Initial              Last Name
                                                                                          Taxpayer SSN
Mailing Address (Number and Street, Including Rural Route)
                                                                                          Spouse SSN
City                                  State               Zip             County Code

  PART I:  TAX RETURN INFORMATION                                                                                        (ROUND TO THE NEAREST DOLLAR)

1    Mississippi taxable income (Form 80-105, line 16; 80-205, line 19)                      1                                                                .00
2    Total Mississippi tax (Form 80-105, line 24; 80-205, line 26)                           2                                                                .00
3    Mississippi tax payments (Form 80-105, line 28; 80-205, line 30)                        3                                                                .00
4    Refund (Form 80-105, line 34; 80-205, line 35)                                          4                                                                .00
5    Amount you owe (Form 80-105, line 37; 80-205, line 38)                                  5                                                                .00

  PART II:  DIRECT DEPOSIT/DIRECT DEBIT

1    Routing number                                                 3    Type of account: Checking                               Savings
2    Account number
4    Routing number                                                 6    Type of account: Checking                               Savings
5    Account number

My request for direct deposit/direct debit of my refund/payment includes my authorization for the Mississippi Department of Revenue to furnish my financial institution with my
routing number, account number, account type, and social security number to insure my refund/payment is properly processed.
  PART III:  DECLARATION OF TAXPAYER

Under penalties of perjury, I declare that I have compared the information contained on my income tax return with the information I have provided to my electronic return
originator and that the amounts described in Part I above agree with the amounts shown on the corresponding lines of my Mississippi income tax return. To the best of my
knowledge and belief, my return is true, correct and complete. This declaration is to be maintained by the electronic return originator and provided to Mississippi Department of
Revenue on request.

Taxpayer Signature                                            Date          Spouse Signature                                              Date

  PART IV:  DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER

Under penalties of perjury, I declare that I have reviewed the above taxpayer's return and that the entries on this form are complete and correctly represented to the best of my
knowledge. I have obtained the taxpayer's signature and will maintain this return for the Mississippi Department of Revenue as part of my permanent records. Upon written
request, I will furnish this return to the Mississippi Department of Revenue. I have provided the taxpayer with a copy of all forms and information to be filed electronically with
the Mississippi Department of Revenue and have followed all other requirements described in the Mississippi Handbook for Electronic Filers and any additional requirements
specified by  the Mississippi Department of Revenue.  If I  am the paid preparer, under  penalties of perjury, I declare that I  have examined this return and accompanying
schedules and statements and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer is based on all information of which
preparer has any knowledge.

ERO      ERO Signature                                               Date   Check if Also                                Check if Self-   ERO SSN or PTIN
Use                                                                         Paid Preparer                                Employed
Only                                                                                                                       EIN
     Firm Name (or yours if self-
     employed), address and  ZIP code                                                                                      Phone No. 

Under penalties of perjury, I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and 
belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.
Paid     Preparer Signature                                          Date   Check if Also                                Check if Self-   Preparer SSN or PTIN
                                                                            Paid Preparer                                Employed
Preparer 
Use Only                                                                                                                   EIN
     Firm Name (or yours if self-
     employed), address and  ZIP code                                                                                      Phone No. 

                                      DO NOT Mail this Document to the Mississippi Department of Revenue






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