Fillable Form 80205198 80205198 80205198.pdf (Mississippi)

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Form 80205198 80205198 80205198.pdf (Mississippi)

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17 Deductions (from line 14b; if itemized, attach Form 80-108)
18 Exemptions (from line 15b)
23 Consumer use tax (see instructions)
26 Mississippi income tax withheld (complete Form 80-107)
20 Income tax due (from Schedule of Tax Computation, see instructions)
19 Mississippi taxable income (line 16 minus line 17 and line 18)
Mississippi
Non-Resident / Part-Year Resident
2019
802051981000
Form 80-205-19-8-1-000 (Rev. 07/19)
27 Estimated tax payments, extension payments and/or amount paid on original return
29 Total payments (line 26 plus line 27 minus line 28)
30 Overpayment (if line 29 is more than line 25, subtract line 25 from line 29)
33 Overpayment to be applied to next year estimated tax account
34 Overpayment refund (line 32 minus line 33)
35 Balance due (if line 25 is more than line 29, subtract line 29 from line 25)
24 Catastrophe savings tax (from Form 80-360, line 14)
22 Net income tax due (line 20 minus line 21)
Non-Resident
16 Mississippi adjusted gross income (from page 2, line 66 or line 67)
13a Mississippi adjusted gross income
b Adjusted gross income from all sources
c Line 13a divided by line 13b
. %
14a Standard or itemized deductions
b Mississippi deductions
(line 14a multiplied by line 13c)
15a Exemptions (from line 12; if married
filing separate, use 1/2 amount)
b Mississippi exemption
(line 15a multiplied by line 13c)
21 Other credits (from Form 80-401, line 1)
31 Interest and penalty (from Form 80-320, line 11 and/or line 12)
28 Refund received and/or amount carried forward from original return (amended return only)
Part-Year, Tax Year Beginning
Amended
Married - Filing Separate Returns ($12,000)
Spouse SSN
County Code
ZipCity
Taxpayer First Name
Last Name
SSN
Spouse First Name
Taxpayer Blind
Taxpayer Age 65 or Over Spouse Age 65 or Over
Spouse Blind
Mailing Address (Number and Street, Including Rural Route)
State
Last Name
4
1
5
2
Married - Combined or Joint Return ($12,000)
Head of Family ($8,000)
Single ($6,000)
3
Married - Spouse Died in Tax Year ($12,000)
8
EXEMPTIONS
PLEASE SIGN THIS TAX RETURN ON THE BOTTOM OF PAGE 2
Individual Income Tax Return
Initial
Initial
9 Total dependents line 7 plus number of boxes checked line 8
12 Total (line 10 plus line 11)
10
10 Line 9 x $1,500
11 Enter filing status exemption
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.00
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11
12
7 Total number of dependents (from line 6 and Form 80-491)
(C) Dependent SSN(A) Name
6
(B)
Dependents (in column B, enter "C" for child, "P" for parent or "R" for relative)
PRORATION (COMPLETE PAGE 2 BEFORE PROCEEDING FURTHER)
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MISSISSIPPI INCOME TAX
REFUND
BALANCE DUE
Farmers or Fishermen
(see instructions)
Installment Agreement Request
(see instructions for eligibility; attach Form 71-661)
16A
17A
18A
19A
16B
17B
18B
19B
21
20
22
23
24
25
26
27
28
29
30
31
32
33
.00
36 Interest and penalty (from Form 80-320, line 19)
.00
34
.00
35
37 Total due (line 35 plus line 36)
Column A (Taxpayer) Column B (Spouse)
32 Adjusted overpayment (line 30 minus line 31)
36
.00
AMOUNT YOU OWE
(If no overpayment is due on line 30, skip to line 35)
25 Total Mississippi income tax due (line 22 plus line 23 and line 24)
37
.00
and Ending
Reset Form
Print Form
48 Other income (loss) (from Form 80-108, part V)
SSN
46 Taxable pensions and annuities (complete Form 80-107)
47 Unemployment compensation (complete Form 80-107)
49 Total income (add lines 38 through 48)
44 Dividend income (from Form 80-108, part II)
45 Alimony received
41 Rent, royalties, partnerships, S corporation, trusts, etc.
(from Form 80-108, part IV)
42 Farm income (loss) (attach Federal Schedule F)
39 Business income (loss) (attach Federal Schedule C or C-EZ)
43 Interest income (from Form 80-108, part II)
Page 2
40 Capital gain (loss) (attach Federal Schedule D, if applicable)
38 Wages, salaries, tips, etc. (complete Form 80-107)
Mississippi Income ONLY
51 Payments to self-employed SEP, SIMPLE and qualified retirement plans
Total Income From All Sources
50 Payments to IRA
58 Self-employed health insurance deduction
52 Interest penalty on early withdrawal of savings
53 Alimony paid (complete below)
55 National Guard or Reserve pay (enter the lesser of amount or $15,000)
54 Moving expense (attach Federal Form 3903)
59 Health savings account deduction
66 Adjusted gross income (line 49 minus line 65; enter total AGI
on page 1, line 13b and Mississippi AGI line 13a)
T
56 Mississippi Prepaid Affordable College Tuition (MPACT)
65 Total adjustments (add lines 50 through 64)
S67 Split Mississippi AGI on line 66 between taxpayer and spouse
802051982000
Form 80-205-19-8-2-000 (Rev. 07/19)
57 Mississippi Affordable College Savings (MACS)
This return may be discussed with the preparer
Yes No
Paid Preparer Signature
Date
Paid Preparer Address
Date
Taxpayer Signature
Taxpayer Phone Number
Paid Preparer PTIN
Paid Preparer Phone Number
City State Zip Code
Spouse Signature
Date
Paid Preparer Email Address
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.
Duplex and Photocopies NOT Acceptable
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Mississippi
Non-Resident / Part-Year Resident
2019
Individual Income Tax Return
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Name
State
SSN
INCOME
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
ADJUSTMENTS Mississippi Income ONLY Total Income From All Sources
AMENDED RETURN - EXPLANATION OF CHANGES TO ORIGINAL RETURN (attach additional statement if needed)
61
38
39
40
41
42
43
44
45
48
49
48
49
52
53
54
55
56
59
60
61
38
39
40
41
42
43
44
45
52
53
54
55
56
59
60
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46 46
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47 47
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50 50
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51 51
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57 57
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58 58
60 Catastrophe savings account deduction
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65
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65
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66
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66
61 Self-employment tax deduction
67
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67
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.00 .00
63 63
62 First-time home buyer saving account deduction
.00
62
.00
62
63 Agricultural disaster program compensation deduction
Date of Divorce
64 Mississippi Achieving a Better Life Experience (ABLE) Act deduction
.00
64
.00
64
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Form 80205198 80205198 80205198.pdf (Mississippi)

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Completed 16 July 2020

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