Special Tax Return Form

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DIRECT 030
Form 72-205-01-2-1-000 (Rev. 4/01)
Mississippi
SP
722050121000
Special Tax Return
Instructions
See reverse for detailed instructions.
Round to nearest dollar. Do not include pennies.
Copies or reproductions of the official form are not acceptable.
This return must be filed, even if no tax is due.
Failure to submit your return on the original form may result in a
Due Date: Due 1st to 20th; delinquent after 20th. Add penalty if
penalty.
delinquent.
Filing Period
Month
Year
Monthly
OR
Quarterly
First Month
Last Month
Year
OR
to
Annual
You MUST use the filing
period assigned by the
Quarterly: 01 to 03, 04 to 06, 07 to 09, or 10 to 12
Tax Comm. Only standard
Account Number:
Annual: 01 to 12
filing
periods
may
be
used.
The periods are:
Address Change.
AMENDED Return
ADDITIONAL Tax
FINAL Return
Change
Make changes above
Close Account
of
Status
(Column 1)
(Column 2)
(Column 3)
Taxable Income
Rate of Tax
Amount of Tax
,
,
.
,
.
.................1/2%.................
00
00
,
,
.
,
.
...................1%..................
00
00
,
,
.
,
.
...............1 1/2%................
00
00
,
,
.
,
.
...................2%..................
00
00
,
,
.
,
.
...............2 1/2%................
00
00
,
,
.
,
.
..................3%...................
00
00
,
,
.
,
.
00
00
,
.
00
1.
Net Tax Due....................................................................
,
.
00
2.
Penalty (See Instructions)..................................................
,
.
00
3.
Credit Adjustments (See Instructions)................................
,
.
00
4.
Additional Assessments (See Instructions).........................
,
.
00
5.
Total Due.........................................................................
I declare, under the penalties of perjury, that this return (including any accompanying schedules) has been examined
by me and to the best of my knowledge and belief is a true, correct and complete return.
Signature of Taxpayer or Agent
Date
Phone Number
Mail Return To:
Mississippi Tax Commission
P. O. Box 960
Jackson, MS 39205

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