Form 80-205-22-8-1-000 (Rev. 10/22)                                                                                         Reset Form
                                                                             Mississippi
                                                                                                                            Print Form
                                                           Non-Resident / Part-Year Resident 
        802052281000                                           Individual Income2022           Tax Return                                       Amended

        Non-Resident                       Part-Year, Tax Year Beginning                             and Ending 
Taxpayer First Name                            Initial      Last Name                                    SSN
                                                                                                         Spouse SSN
Spouse First Name                              Initial      Last Name
                                                                                                         1         Married - Combined or Joint Return ($12,000)
Mailing Address (Number and Street, Including Rural Route)                                               2         Married - Spouse Died in Tax Year ($12,000)
                                                                                                         3         Married - Filing Separate Returns ($12,000)
City                                           State       Zip                     County Code           4         Head of Family ($8,000)
                                                                                                         5         Single ($6,000)
  EXEMPTIONS 
Dependents  (in column B, enter "C" for child, "P" for parent or "R" for relative) 8                Taxpayer Age 65 or Over      Spouse Age 65 or Over
6  (A)   Name                                (B)           (C)  Dependent SSN                       Taxpayer Blind               Spouse Blind

                                                                                   9     Total dependents line 7 plus number of boxes checked line 8
                                                                                   10   Line 9 x $1,500                     10                                 00
                                                                                                                                                            .
                                                                                   11   Enter filing status exemption       11                                 00
                                                                                                                                                            .
7      Total number of dependents (from line 6 and Form 80-491)                    12   Total (line 10 plus line 11)        12                                 00
                                                                                                                                                            .
  PRORATION                                                (COMPLETE PAGE 2 BEFORE PROCEEDING FURTHER)  
13a  Mississippi adjusted gross income                         14a  Standard or itemized deductions                15a  Exemptions (from line 12; if married   
                                                                                                                           filing separate, use 1/2 amount)
                                       .00                                                          .00
       bAdjusted gross income from all sources                        bMississippi deductions                                                                  00
                                                                                                                                                            .
                                                                       (line 14a multiplied by line 13c)                  bMississippi exemption  
       cLine 13a divided by line 13b.00                                                                                    (line 15a multiplied by line 13c)
                                                                                                    .00
                    .                  %                                                                                                                    .00
  MISSISSIPPI INCOME TAX                                                                       Column A (Taxpayer)                     Column B (Spouse)
16    Mississippi adjusted gross income (from page 2, line 67 or line 68)          16A                             .00      16B                                00
                                                                                                                                                            .
17    Deductions (from line 14b; if itemized, attach Form 80-108)                  17A                             .00      17B                                00
                                                                                                                                                            .
18    Exemptions (from line 15b)                                                   18A                             .00      18B                                00
                                                                                                                                                            .
19    Mississippi taxable income (line 16 minus line 17 and line 18)               19A                             .00      19B                                00
                                                                                                                                                            .
20    Income tax due (from Schedule of Tax Computation, see instructions)                                                        20                         .00
21    Credit for tax paid on an electing Pass-Through Entity Tax Return (from Form 80-161, line 3d)                              21                         . .0000
22    Other credits (from Form 80-401, line 1)                                                                                   22                            0000
                                                                                                                                                            . .
23    Net income tax due (line 20 minus line 21 and line 22)                                                                     23                            00
                                                                                                                                                            .
24    Consumer use tax (see instructions)                                                                                        24                            00
                                                                                                                                                            .
25      Catastrophe savings tax (see instructions)                                                                               25                            00
                                                                                                                                                            .
26    Total Mississippi income tax due       (line 23 plus line 24 and line 25)                                                  26                         .00
27    Mississippi income tax withheld (complete Form 80-107)                                                                     27                            00
                                                                                                                                                            .
28    Estimated tax payments, extension payments and/or amount paid on original return                                           28                            00
                                                                                                                                                            .
29    Refund received and/or amount carried forward from original return (amended return only)                                   29                            00
                                                                                                                                                            .
30    Total payments (line 27 plus line 28 minus line 29)                                                                        30                            00
                                                                                                                                                            .
31    Overpayment (if line 30 is more than line 26, subtract line 26 from line 30; if zero, skip to line 36)                     31                            00
                                                                                                                                                            .
32    Interest and penalty (from Form 80-320, line 11 and/or line 12)                                                            32                            00
                                                                                                                                                            .
33    Adjusted overpayment (line 31 minus line 32)                                                                               33                         .00
34    Overpayment to be applied to next year estimated tax account                 Farmers or Fishermen                          34                            00
                                                                                                                                                            .
35    Overpayment refund (line 33 minus line 34)                                   (see instructions)        REFUND
                                                                                                                                 35                         .00
                 Direct Deposit Request
                 (check box and go to page 3)
36    Balance due (if line 26 is more than line 30, subtract line 30 from line 26)                       BALANCE DUE             36                         .00
37    Interest and penalty (from Form 80-320, line 19)                                                                           37                         .00
38    Total due (line 36 plus line 37)                                                               AMOUNT YOU OWE              38                         .00
                 Installment Agreement Request 
                 (see instructions for eligibility; attach Form 71-661)

                                             PLEASE SIGN THIS TAX RETURN ON THE BOTTOM OF PAGE 3

Form 80-205-22-8-2-000 (Rev. 10/22)
                                                                   Mississippi
                                                  Non-Resident / Part-Year Resident                             Page 2
                                                          Individual Income Tax Return
      802052282000                                                   2022

                                                                                        SSN

  INCOME                                                                     Total Income From All Sources      Mississippi Income ONLY

39    Wages, salaries, tips, etc. (complete Form 80-107)                    39          00                 39         .00
                                                                                       .
40    Business income (loss) (attach Federal Schedule C or C-EZ)            40          00                 40         .00
                                                                                       .
41    Capital gain (loss) (attach Federal Schedule D, if applicable)        41          00                 41         .00
                                                                                       .
42    Rent, royalties, partnerships, S corporations, trusts, etc.           42         .00                 42         .00
        (from Form 80-108, part IV)
43    Farm income (loss) (attach Federal Schedule F)                        43          00                 43         .00
                                                                                       .
44    Interest income (from Form 80-108, part II, line 3)                   44          00                 44         .00
                                                                                       .
45    Dividend income (from Form 80-108, part II, line 6)                   45          00                 45         .00
                                                                                       .
46    Alimony received                                                      46          00                 46         .00
                                                                                       .
47    Taxable pensions and annuities (complete Form 80-107)                 47          00                 47         .00
                                                                                       .
48    Unemployment compensation (complete Form 80-107)                      48          00                 48         .00
                                                                                       .
49    Other income (loss) (from Form 80-108, part V, line 10)               49          00                 49         .00
                                                                                       .
50    Total income (add lines 39 through 49)                                50          00                 50         .00
                                                                                       .
  ADJUSTMENTS                                                                Total Income From All Sources      Mississippi Income ONLY

51    Payments to IRA                                                       51          00                 51         .00
                                                                                       .
52    Payments to self-employed SEP, SIMPLE and qualified retirement plans  52          00                 52         .00
                                                                                       .
53    Interest penalty on early withdrawal of savings                       53          00                 53         . .0000
                                                                                       .
54    Alimony paid (complete below)                                         54          00                 54         .00
                                                                                       .
  Name                                                SSN                        State Date of Divorce

55    Moving expense (attach Federal Form 3903)                             55          00                 55         .00
                                                                                       .
56    National Guard or Reserve pay (enter the lesser of amount or $15,000) 56          00                 56         .00
                                                                                       .
57    Mississippi Prepaid Affordable College Tuition (MPACT)                57          00                 57         .00
                                                                                       .
58    Mississippi Affordable College Savings (MACS)                         58          00                 58         .00
                                                                                       .
59    Self-employed health insurance deduction                              59          00                 59         .00
                                                                                       .
60    Health savings account deduction                                      60          00                 60         .00
                                                                                       .
61    Catastrophe savings account deduction                                 61         .00                 61         .00
62    Self-employment tax deduction                                         62         .00                 62         .00
63    First-time home buyer saving account deduction                        63         .00                 63            00
                                                                                                                      .
64    Agricultural disaster program compensation deduction                  64         .00                 64         .00
65    Mississippi Achieving a Better Life Experience (ABLE) Act deduction   65         .00                 65            00
                                                                                                                      .
66    Total adjustments (add lines 51 through 65)                           66         .00                 66            00
                                                                                                                      .
67    Adjusted gross income (line 50 minus line 66; enter total AGI         67         .00                 67         .00
        on page 1, line 13b and Mississippi AGI line 13a)
68    Split Mississippi AGI on line 67 between taxpayer and spouse          T 68       .00                 S 68       .00

  AMENDED RETURN - EXPLANATION OF CHANGES TO ORIGINAL RETURN  (attach additional statement if needed)

Form 80-205-22-8-3-000 (Rev. 10/22)
                                                                Mississippi
                                               Non-Resident / Part-Year Resident                                                 Page 3
                                                            Individual Income Tax Return
  802052283000                                                    2022

                                                                                                     SSN

  DIRECT DEPOSIT INFORMATION

1 Overpayment refund (from page 1, line 35)                                                                    1                                             .00

a Routing Number 1                             Account Number 1   Checking                   Savings                       Direct Deposit 1 Amount

                                                                                                               1a                                            .00

b Routing Number 2                             Account Number 2   Checking                   Savings                       Direct Deposit 2 Amount

                                                                                                               1b                                            .00

  SIGNATURE

This return may be discussed with the preparer Yes              No

I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, 
this is a true, correct and complete return.  Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. 

  Taxpayer Signature                           Date               Taxpayer  Phone Number     Paid Preparer PTIN

  Spouse Signature                             Date               Paid Preparer Phone Number Paid Preparer Email Address

  Paid Preparer Signature                      Date               Paid Preparer Address      City                          State Zip Code

                                    Mail REFUND returns to: Department of Revenue, P.O. Box 23058, Jackson, MS 39225-3058  
                                   Mail all other returns to: Department of Revenue, P.O. Box 23050, Jackson, MS 39225-3050
                                               Duplex and Photocopies NOT Acceptable