Form 80-205-12-8-1-000 Non-Resident / Part-Year Resident Individual Income Tax Return 2012

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Mississippi
Form 80-205-12-8-1-000 (Rev. 05/12)
Non-Resident / Part-Year Resident
MS
Page 1
Individual Income Tax Return
2012
Amended
802051281000
Non-Resident
Part-Year
From
__ __ __ __
To
__ __ __ __
Taxpayer Last Name
Middle Initial
First Name
YOU MUST ENTER SSN
Spouse First Name
Middle Initial
Spouse Last Name
__ __ __ - __ __ - __ __ __ __
SSN
Mailing Address (Number & Street, Including Rural Route)
__ __ __ - __ __ - __ __ __ __
Spouse SSN
State
Zip
City
__ __
Residence County Code - See Instructions
Married - Combined or Joint Return
1.
7.
Mark "X" ONLY if:
(Enter $12,000 on Line 12.)
Married - Spouse Died in Tax Year - Enter surviving spouse first as taxpayer
Taxpayer Blind
.
Taxpayer Age 65 or Over
2.
(Enter $12,000 on Line 12. Enter Spouse Name and SSN in boxes provided above.
Spouse Age 65 or Over
Spouse Blind
Married - Filing Separate Returns
(Enter $12,000 on Line 12. Enter Spouse Name and SSN in
3.
__
boxes provided above. Cannot change from Joint to Separate after due date.)
8. Number of Boxes Marked "X" on Line 7.
Head of Family
4.
(Enter $8,000 on Line 12. Provide Name, SSN, and Relationship of the Dependent
__ __
9. Number of Dependents Listed on Line 6.
Living in the Home with You on Line 6.)
(List additional dependents on Form 80-491)
5.
Single -
(Enter $6,000 on Line 12)
__ __
10. Total of Line 8 plus Line 9.
Dependents (In column (B ) Must enter C for child, P for parent, or R for relative)
6.
__ __, __ __ __.
00
(B)
$1,500
(A) Name
(C) Dependent SSN
11. Line 10 x
___
__ __ __ - __ __ - __ __ __ __
12. Enter Amount from
__ __, __ __ __.
00
Lines 1 through 5.
__ __ __ - __ __ - __ __ __ __
___
__ __, __ __ __.
00
13. Total (Line 11 plus 12).
14. If Filing MFS Returns,
__ __ __ - __ __ - __ __ __ __
__ __, __ __ __.
00
___
Enter 1/2 of Line 13.
COMPLETE SCHEDULE OF INCOME ON PAGE 2 BEFORE PROCEEDING FURTHER. (See Instructions)
15a. MS Adjusted Gross Income
17a. Exemption, Line 13 above or Line 14 if MFS
16a. Standard or Itemized Deduction
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
b. MS Exemption 17a Times 15c
b. Total Adjusted Gross Income From All Sources
b. MS Deduction, 16a Times 15c
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
c. Line 15a Divided by 15b
__ __ __ . __ __
%
Column A (Taxpayer)
Column B (Spouse)
Round to Nearest Dollar
18. Mississippi Adjusted Gross Income
(From Line
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00
__, __ __ __, __ __ __.
00
61 or 62, Page 2)
__, __ __ __, __ __ __.
00
19. Standard or Itemized Deductions
__, __ __ __, __ __ __.
00
Enter Amount From
16b (If Itemized,Must Attach Schedule A, Form 80-108,)
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
20. Amount of Exemption
(Line 17b)
21. Mississippi Taxable Income (L
ine 18 minus Line 19
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00
__, __ __ __, __ __ __.
00
and 20) See Instructions (If less Than 0, Enter 0)
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00
22. Total Income Tax Due (From Schedule of Tax Computation, Form 80-100)
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00
23. Credit for Tax Paid to Another State (See Instructions Form 80-100 for Eligibility)
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00
24. Other Credits (From Form 80-401, Line 1)
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00
25. Net Income Tax Due (Line 22 minus Line 23 and 24)
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00
26. Consumer Use Tax (See Instructions, Form 80-100)
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00
27. Total Tax Due (Line 25 plus Line 26)
28. Mississippi Income Tax Withheld (Must complete Form
__, __ __ __, __ __ __.
00
80-107)
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00
29. Estimated Tax Payments and/or Amount Paid for Original Return
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00
30. Total Payments (Line 28 plus Line 29)
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00
31. Refund Received And/Or Amount Carried Forward from Original Return (Amended Return Only)
__, __ __ __, __ __ __.
00
32. Overpayment (If Line 30 is larger than Line 27 plus Line 31)
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00
33. Overpayment to be Applied to Next Year Estimated Tax Account
__, __ __ __, __ __ __.
00
34. Refund (Line 32 minus Line 33)
__, __ __ __, __ __ __.
00
35. Balance Due (If Line 27 plus Line 31 is larger than Line 30)
__, __ __ __, __ __ __.
00
36. Interest and Penalty (Including Interest on Underpayment of Estimated Tax, Form 80-320)
__, __ __ __, __ __ __.
00
37. Total Due (Line 35 plus Line 36)
Duplex and Photocopies NOT Acceptable

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