Form 80-105-22-3-1-000 (Rev. 11/22)
0606 0707 080 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 808 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
0404 Mississippi 0404
0505 0505
Resident Individual Income Tax Return
0606 801052231000 0606
0707 2022 X Amended 0707
0808 0808
0909 Taxpayer First Name Initial Last Name SSN 0909
999999999
1010XXXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXX Spouse SSN 999999999 1010
1111 Spouse First Name Initial Last Name 1111
1212XXXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXX 1 X Married - Combined or Joint Return ($12,000) 1212
1313 Mailing Address (Number and Street, Including Rural Route) 2 X Married - Spouse Died in Tax Year ($12,000) 1313
1414X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X 3 X Married - Filing Separate Returns ($12,000) 1414
1515 City State Zip County Code 4 X Head of Family ($8,000) 1515
1616XXXXXXXXXXXXXXXXXXXXX XX 99999 99 5 X Single ($6,000) 1616
1717 1717
EXEMPTIONS
1818 1818
1919Dependents (in column B, enter "C" for child, "P" for parent or "R" for relative) 8 X Taxpayer Age 65 or Over X Spouse Age 65 or Over 1919
20206 (A) Name (B) (C) Dependent SSN X Taxpayer Blind X Spouse Blind 2020
2121 XXXXXXXXXXXXXXXXXX X 999999999 2121
2222 XXXXXXXXXXXXXXXXXX X 999999999 9 Total dependents line 7 plus number of boxes checked line 8 99 2222
2323 XXXXXXXXXXXXXXXXXX X 999999999 2323
2424 XXXXXXXXXXXXXXXXXX X 999999999 10 Line 9 x $1,500 10 9999999999 2424
2525 11 Enter filing status exemption 11 9999999999 2525
26267 Total number of dependents (from line 6 and Form 80-491) 99 12 Total (line 10 plus line 11) 12 9999999999 2626
2727 2727
2828 MISSISSIPPI INCOME TAX Column A (Taxpayer) Column B (Spouse) 2828
292913 Mississippi adjusted gross income (from page 2, line 66) 13A 9999999999 13B 9999999999 2929
303014 Standard or itemized deductions (if itemized, attach Form 80-108) 14A 9999999999 14B 9999999999 3030
313115 Exemptions (from line 12; if married filing separately use 1/2 amount) 15A 9999999999 15B 9999999999 3131
323216 Mississippi taxable income (line 13 minus line 14 and line 15) 16A 9999999999 16B 9999999999 3232
333317 Income tax due (from Schedule of Tax Computation, see instructions) 17 9999999999 3333
343418 Credit for tax paid to another state (from Form 80-160, line 13; attach other state return) 18 9999999999 3434
353519 Credit for tax paid on an electing Pass-Through Entity Tax Return (from Form 80-161, line 3d) 19 9999999999 3535
363620 Other credits (from Form 80-401, line 1) 20 9999999999 3636
373721 Net income tax due (line 17 minus line 18, line 19 and line 20) 21 9999999999 3737
383822 Consumer use tax (see instructions) 22 9999999999 3838
393923 Catastrophe savings tax (see instructions) 23 9999999999 3939
404024 Total Mississippi income tax due (line 21 plus line 22 and line 23) 24 9999999999 4040
4141 4141
4242 PAYMENTS 4242
434325 Mississippi income tax withheld (complete Form 80-107) 25 9999999999 4343
444426 Estimated tax payments, extension payments and/or amount paid on original return 26 9999999999 4444
454527 Refund received and/or amount carried forward from original return (amended return only) 27 9999999999 4545
464628 Total payments (line 25 plus line 26 minus line 27) 28 9999999999 4646
4747 REFUND OR BALANCE DUE 4747
4848 4848
494929 Overpayment (if line 28 is more than line 24, subtract line 24 from line 28; if zero, skip to line 35) 29 9999999999 4949
505030 Interest and penalty (from Form 80-320, line 11 and/or line 12) 30 9999999999 5050
515131 Adjusted overpayment (line 29 minus line 30) 31 9999999999 5151
525232 Overpayment to be applied to next year estimated tax account X Farmers or Fishermen 32 9999999999 5252
(see instructions)
535333 Voluntary contribution (from Form 80-108, part III) 33 9999999999 5353
545434 Overpayment refund (line 31 minus line 32 and line 33) REFUND 34 9999999999 5454
5555 5555
5656 Direct Deposit Request 5656
X (check box and go to page 3)
5757 5757
585835 Balance due (if line 24 is more than line 28, subtract line 28 from line 24) BALANCE DUE 35 9999999999 5858
595936 Interest and penalty (from Form 80-320, line 19) 36 9999999999 5959
606037 Total due (line 35 plus line 36) AMOUNT YOU OWE 37 9999999999 6060
6161 6161
6262 X Installment Agreement Request 6262
(see instructions for eligibility; attach Form 71-661)
6363 6363
0606 0707 080 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26PLEASE27 28 29 30 31SIGN32 33 34THIS35 36 37TAX38 39RETURN40 41 42 43 44ON45 46THE47 48 49BOTTOM50 51 52 53 54OF55 56PAGE57 58 59360 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 808 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80