Payment Voucher For Individual Income Tax Form
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1MISSISSIPPI
WIR
Payment Voucher For Individual
801069981000
Income Tax
1999
Your Social Security Number
Spouse's Social Security Number
Form 80-106-99-8-1-000 (Rev. 12/99)
Photocopies NOT Acceptable
Taxpayer's Last Name
First Name & Middle Initial
Spouse's First Name & Middle Initial
Whole Dollars Only
Amount of Your Payment
Mailing Address (Number and Street, including Rural Route)
State
Zip
City
Print Social Security Number
on check. Include Spouse's
SSN if JOINT ACCOUNT
Submit with Income Tax Return
Cut Along Line
This voucher must be filed with all Returns when payment is due.
Failure to file this
voucher with your return could cause a delay in the processing of the return. If you do not need to make a payment,
do not use this voucher.
Payment Voucher
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