70-698 Form Request For Copies Of Tax Returns

REQUEST FOR COPIES OF TAX RETURNS

Form 70-698

Request may be rejected if the form is incomplete, illegible or any required line was blank. Payment must be made prior to issuing copies. You may contact the Department

of Revenue at 601 923-7700 and ask for the Tax Area responsible for the administration of the tax type you are requesting copies from to determine how many pages your

request will generate. This will determine the cost. The Account Number is the Social Security Number (SSN) for Individual Income Tax, the Federal Employer’s Identification

Number (FEIN) for Corporate Income Tax and Withholding Tax, and the Sales and/or Use Tax Account Number for most other tax types. For Individual Income Tax Returns that

are filed jointly, both spouses SSNs and names are required before copies can be released.

ACCOUNT NUMBER: ______________________ TAX TYPE: ____________________ TAX PERIOD: ____________________

ACCOUNT NUMBER: ______________________ TAX TYPE: ____________________ TAX PERIOD: ____________________

ACCOUNT NUMBER: ______________________ TAX TYPE: ____________________ TAX PERIOD: ____________________

ACCOUNT NUMBER: ______________________ TAX TYPE: ____________________ TAX PERIOD: ____________________

Name and address where to send the copies of the requested returns. If you want these copies certified, please check here.

Name:

_____________________________________________________________________________________

Address:

_____________________________________________________________________________________

City, State, Zip:

_____________________________________________________________________________________

Phone Number:

_____________________________________________________________________________________

The “Mississippi Public Records Act of 1983” requires the following charges be submitted before delivery of the reproduced documents. Payments

must be in the form of cash, a cashier’s check or money order. We do not accept personal checks for copies. We do not recommend you send

cash through the mail. The charge for copies is $2.50 for the first page and $.50 for each additional page. We will return this document with

the charge on it. Please allow 7 days for processing. Contact this office at 601-923-7700 to determine the cost of the copies. Ask for the Tax

Area responsible for the tax type of the return you have requested.

Signature of Taxpayer(s):

Under penalties of perjury, I declare that I am either the taxpayer whose name is shown above or a person authorized

to obtain the tax return requested. If the request applies to a joint return, either spouse can sign. If signed by a corporate officer, partner, guardian,

executor, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute this form on behalf of the taxpayer.

Taxpayer Signature: ______________________________________________________ Date: ___________________

Spouse Signature: _________________________________________________________________________________

Title

: _________________________________________________________

if officer, partner, trustee or party other than taxpayer

Contact Phone Number: _____________________________________________________________________________________

AFFIDAVIT

STATE OF __________________________________

COUNTY OF _____________________________________

Before me, the undersigned authority, on this day personally appeared ________________________________________________,

known to me to be the person whose name is subscribed to the foregoing authorization and who, after being by me duly sworn, upon

oath states that same was executed for the purpose therein expressed.

SUBSCRIBED and SWORN to me, a Notary Public, on the _______________ day of ____________________________, 20______.

My Commission Expires:_______________________________

________________________________________________

Notary Public

NUMBER OF PAGES COPIED: ___________ TOTAL COST: $___________ DATE PAYMENT RECEIVED: ________________

INITIAL AND DATE WHEN RETURNS WERE COPIED AND SENT: ____________________________________________________