Form 80-270-04-8-1-000 - Mississippi Non-Resident / Part-Year Resident Amended Individual Income Tax Return Form - Office Of Revenue

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Mississippi Non-Resident / Part-Year Resident
Form 80-270-04-8-1-000 (Rev.12/04)
Individual Income Tax Return
AMENDED
WI A
Page 1
TAX YEAR
Photocopies NOT Acceptable
802700481000
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Middle Initial
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Taxpayer Last Name
First Name
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SSN
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Middle Initial
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Spouse Last Name
Spouse Last Name
Spouse First Name
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Spouse
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SSN
Mailing Address (Number & Street, Including Rural Route)
YOU MUST ENTER SSN
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Zip
City
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Residence County Code - See Instructions
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Married - Combined or Joint Return - Enter $12,000 on Line 12.
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Mark "X" ONLY if:
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Taxpayer Age 65 or Over
Taxpayer Blind
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Married - Spouse Died in Tax Year - Enter $12,000 on Line 12. Enter Spouse Name and
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SSN in boxes provided above.
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Married - Filing Separate Returns - Enter $12,000 on Line 12. Enter Spouse Name and
Spouse Age 65 or Over
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Spouse Blind
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SSN in boxes provided above. (Cannot change from Joint to Separate after due date.)
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Number of Dependents Listed on Line 6
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Head of Family - Enter $8,000 on Line 12.
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Provide Name, SSN, and Relationship of the
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Dependent Living in the Home with You on Line 6.
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Number of Boxes Marked "X" on Line 7
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Single - Enter $6,000 on Line 12.
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Dependents (In column (B) enter C for child, P for parent, or R for relative)
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Total of Line 8 plus Line 9
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(a) Name
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(c) Dependent SSN
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$ 1,500
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Line 10 x
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Enter Amount from
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Lines 1 through 5.
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13. Total (Line 11 plus 12).
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If Filing MFS Returns,
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Enter 1/2 of Line 13.
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COMPLETE SCHEDULE OF INCOME ON PAGE 2 BEFORE PROCEEDING FURTHER. The Exemption and Deduction (Standard or Itemized) Must be Prorated
According to the Ratio of Mississippi Income to Total Income of Taxpayer and Spouse from all Sources.
15. Ratio Computation
16. Standard or Itemized Deduction Computation
17. Exemption Computation
a. MS Adjusted Gross Income
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a. Standard or Itemized Deduction
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a. Exemption, Line 13 above. (Line 14 if MFS)
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b. Total Adjusted Gross Income From All Sources
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b. MS Deduction, 16a Times 15c
b. MS Exemption, 17a Times 15c
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c. Ratio, Line 15a Divided by 15b
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If Filing Combined Return, Use Column A for
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Column B (Spouse)
Column A (Taxpayer)
Taxpayer and Column B for Spouse, Otherwise Use
Round to Nearest Dollar
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Column A ONLY.
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(P)
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Mississippi Adjusted Gross Income
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(From Line 52 or 53, Page 2)
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(F)
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Standard or Itemized Deductions
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(Line 16b)
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20.
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Amount of Exemption (Line 17b)
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Mississippi Taxable Income (Line 18 minus Lines 19
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& 20) See Instructions. If Less Than 0, Enter 0.
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Total Income Tax Due.
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23.
Mississippi Income Tax Withheld (Attach W-2s.)
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Estimated Tax Payments, Amount Paid with Extension and/or Amount Paid with ORIGINAL RETURN
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LESS AMOUNT OF OVERPAYMENT (Line 27) FROM ORIGINAL RETURN.
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25.
Other Credits (See Instructions.)
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26.
Total Credits (Add Lines 23 through 25.)
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REFUND
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27.
Enter Amount of Refund if Line 26 is Larger than Line 22.
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BALANCE DUE
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28.
Enter Balance Due if Line 22 is Larger than Line 26.
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Interest on Underpayment of Estimated Tax Payments (Attach Form 80-320.)
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30.
Interest and Penalty (See Instructions)
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TOTAL DUE (Add Lines 28, 29, and 30.) Attach Check or Money Order for Total Due
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payable to: State Tax Commission > ENCLOSE PAYMENT VOUCHER 80-106<
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PLEASE SIGN THIS TAX RETURN IN THE SIGNATURE AREA PROVIDED ON THE BOTTOM OF PAGE 2.
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Mail AMENDED RETURN To: Office of Revenue, P.O. Box 23058, Jackson, MS 39225-3058
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