Form 89-140 - Annual Information Return - 2005

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STAPLE Here
MISSISSIPPI
Attachments on the Back
ANNUAL INFORMATION RETURN
CALENDAR YEAR 2005
Form 89-140
Rev. 10/05
ROUTE TO WITHHOLDING
KEEP WITH W2's OR 1099's
FEIN
-
Name
Address
Paper: 99 or fewer
Magnetic Media:
W-2's or 1099's
100 or more W-2's
or 1099's
Must be Postmarked
by January 31, 2006,
City
State
Zip
otherwise, Magnetic
Media must be filed.
Visit our website for the latest on Magnetic Media Reporting:
FOR EACH CATEGORY, A SEPARATE FORM 89-140 MUST BE SUBMITTED
Information return category:
W-2
W-2C
W-2G
1042-S
1099 - Type
See Instructions
on back
,
1. Number of accompanying information returns.
,
,
.
00
2.
Total Mississippi wages or compensation for the calendar year.
,
,
.
3. Total Mississippi income tax withheld by category checked above.
00
,
,
.
4. Total tax remitted for 2005 tax year by category checked above.
00
Do not include interest and penalty in this amount.
If lines 3 and 4 are not the same, see instructions on the back of this form.
Do not send payment with this form. Credit will not be applied to your account if you submit payment with this form.
Amended or additional 89-105 returns must be filed for any underpayment or overpayment. See instructions.
Date
Signature
Phone
(
)
Submitting Company Phone
Submitting Company (If different from above)
(
)
Contact Person
Address

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