Duplex and Photocopies NOT acceptable
2019
Form 80-108-19-8-1-000 (Rev. 07/19)
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.
b Less Mississippi gambling losses
2 a Medical and dental expenses
b Multiply line 1 by 10% (.10).
3 a Total taxes paid
4 Total interest paid
5 Charitable contributions
6 Total casualty or theft loss (attach Federal Form 4684)
7 a Other miscellaneous deductions
8 Mississippi itemized deductions (add lines 2c, 3c, 4, 5, 6, 7c); enter here and on Resident Form 80-105,
page 1, line 14 or Non-Resident Form 80-205, page 1, line 14a
b Less state income taxes (or other taxes in lieu of)
c Total other miscellaneous deductions (line 7a minus line 7b)
c Total taxes paid deduction (line 3a minus line 3b)
c Medical and dental expense deduction (line 2a minus line 2b)
1 Interest income from all sources
2 Amount of Mississippi nontaxable interest in line 1
3 Total Mississippi interest (line 1 minus line 2, enter here and on Form 80-105, line 42 or Form 80-205, line 43)
5 Amount of Mississippi nontaxable distributions reported in line 4
6 Total Mississippi dividends (line 4 minus line 5, enter here and on Form 80-105, line 43 or Form 80-205, line 44)
4 Total dividends from all sources
Mississippi
Adjustments And Contributions
SSN
801081981000
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
Wildlife Heritage Fund
Educational Trust Fund
Commission for Volunteer Service FundBurn Care Fund
Wildlife Fisheries and Parks Foundation
Enter total of check-offs here and on Form 80-105, page 1, line 32
2a
Taxpayer Name
2b
3a
3b
7a
7b
1
2
3
4
5
6
.00
.00
.00.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
1 Federal AGI from Federal Form 1040, page 1, line 8b
.00
1
8
.00
2c
3c
4
5
6
.00
.00
.00
.00
.00
7c
.00
PART I: SCHEDULE A - ITEMIZED DEDUCTIONS (ATTACH FEDERAL FORM 1040 SCHEDULE A)
PART II: SCHEDULE B - INTEREST AND DIVIDEND INCOME (FROM FEDERAL FORM 1040, SCHEDULE B)
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