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State of Mississippi
Department of Employment Security
Jackson, MS
REQUEST FOR REFUND
Give exact name of business, address and account number as identified on your contribution report.
Mail to: MDES Tax Department
PO Box 22781
Jackson, MS 39225-2781
Fax to: (601) 321-6011
Email to: tax@mdes.ms.gov
BUSINESS NAME AND ADDRESS: DATE: ___________________________
_____________________________________________ ACCOUNT NO: ____________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
EMPLOYER’S SIGNATURE/TITLE: __________________________________________________________
Employers who have paid more tax than is due for the quarter may be eligible for a refund, unless there is a debit on the account
in another quarter, in which case, the amount will be used to satisfy the debit. Any credit existing afterwards may be refunded
upon written request of the employer. Eligibility for refunds may be determined 45 days after the date of payment and
verification that the account is in good standing. Credits remain available for refund for a period of three years after the end of
the calendar year for which the credit was created. Credits not used or requested as a refund within the three-year period will
result in forfeiture of the credit
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