Mississippi Registration Application Forms And Instructions (Page 2 of 4) in pdf

Mississippi Registration Application Forms and Instructions, p. 2

must attach the approved documents from Mississippi Development

Lawrence, Lincoln, Pike,

Simpson, Walthall, and

1385 Johnny Johnson Dr.

Authority (MDA).

Wilkinson

Ph: (601) 833-4761 Fax: (601) 833-3096

Section E: Withholding Tax

Calhoun, Chickasaw,

Columbus District Service Office

23. Date Mississippi Taxable Wages First Paid

Choctaw, Clay,

P.O. Box 8885

Lowndes, Monroe,

Columbus, MS 39705

You should enter the date Mississippi taxable wages were first paid

Noxubee, Oktibbeha,

to employees.

Webster, and Winston

4072 Highway 45 N.

24. Estimated Monthly Liability

Ph: (662) 328-3271 Fax: (662) 328-1290

You should enter the amount of estimated monthly withholding tax

liability that you anticipate. This is the amount that employers are

Attala, Bolivar, Carroll,

Greenwood District Service Office

required to deduct and withhold, regardless of whether the amounts

Grenada, Holmes,

P.O. Drawer D

were in fact deducted or withheld.

Humphreys, Issaquena,

Greenwood, MS 38935

Leflore, Montgomery,

25. Number of Mississippi Employees

Sharkey, Sunflower,

You should enter the number of employees from which you withhold

Tallahatchie,

117B Grand Bvld.

Mississippi taxes.

Washington, and Yazoo

Ph: (662) 453-1742 Fax: (662) 453-7981

26. Employee Leasing Company

You should place an “X” in the appropriate box to indicate whether

Hancock, Harrison, and

Gulf Coast District Service Office

or not your company is in the business of leasing employees to other

Jackson

1141 Bayview Ave., Ste. 400

Biloxi, MS 39530-1601

companies. Taxpayers applying for Withholding Tax (Employee

Leasing) must give a bond in an amount sufficient to cover twice the

Ph: (228) 436-0554 Fax: (228) 436-0964

estimated tax liability for a period of three (3) months. The bond

must be filed with the Commissioner prior to beginning business in

Covington, Forrest,

Hattiesburg District Service Office

Mississippi. More information can be obtained by contacting your

George, Greene, Jones,

P.O. Box 1709

District Service Office.

Lamar, Marion, Pearl

Hattiesburg, MS 39403-1709

River, Perry, and Stone

27. Location of Records

You should indicate the address, by placing an “X” in the appropriate

17JM Tatum Industrial Dr, Ste. 2

Ph: (601) 545-1261 Fax: (601) 584-4051

box, where the records that support the taxpayer’s withholding tax

returns will be maintained, either the headquarters or the physical

Hinds, Madison, Rankin,

Jackson District Service Office

address listed on the first page. If neither, check “Other” and fill in

and Warren

P.O. Box 1033

the space with the other address.

Jackson, MS 39215-1033

Section F: Applicant Signature

1577 Springridge Rd. Raymond, MS

The Registration Application must be signed and dated by an

Ph: (601) 923-7300 Fax: (601) 923-7318

authorized individual; that is, one of the following:

Clarke, Jasper, Kemper,

Meridian District Service Office

A corporate officer if the taxpayer is a Corporation or S

Lauderdale, Leake,

P.O. Box 3625

Corporation.

Neshoba, Newton, Scott,

Meridian, MS 39305

A managing partner if the taxpayer is a Limited Partnership

Smith, and Wayne

or all general partners if the taxpayer is a General Partnership.

2600 Old N Hills St.

The owner if the taxpayer is a Sole Proprietor.

Ph: (601) 483-2273 Fax: (601) 693-2473

If you submit a Registration Application without an authorized

signature, the application will not be processed.

Benton, Coahoma,

Senatobia District Service Office

DeSoto, Lafayette,

P.O. Box 127

After you have completed the Registration Application, mail it to the

Marshall, Panola,

Senatobia, MS 38668

appropriate address listed below.

Quitman, Tate, Tunica,

Yalobusha, and

115 S. Ward St.

Memphis, Tennessee

Ph: (662) 562-4489 Fax: (662) 562-7392

Alcorn, Itawamba, Lee,

Tupelo District Service Office

Pontotoc, Prentiss,

P.O. Box 3000

Tippah, Tishomingo, and

Tupelo, MS 38803

Union

2610 Traceland Dr.

Ph: (662) 842-4316 Fax: (662) 842-5041

Out of State, except for

Collections Division

Memphis, TN

P.O. Box 23338

Jackson, MS 39225

1577 Springridge Rd. Raymond, MS

Ph: (601) 923-7390 Fax: (601) 923-7334

NAIC

NAIC Category

(New)

County of Business &

Mail to:

210000 Mining

Out of State Location

State Tax Commission

213111 Drilling Oil & Gas Wells

213112 Oil and Gas Field Services including Production

Adams, Amite,

Brookhaven District Service Office

Claiborne, Copiah,

P.O. Box 3999

220000 Utilities

Franklin, Jefferson,

Brookhaven, MS 39603-7999

221120 Electrical Companies and Systems

Jefferson Davis,

221122 EPA’s

Mississippi Registration Application Forms And Instructions Page 2

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