Form 80-110-09-8-2-000 - Mississippi Ez Individual Income Tax Return - 2010

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Form 80-110-10-8-1-000 (Rev. 05/10)
Mississippi
EZ Individual
WIZ
Income Tax Return
801101081000
2010
Duplex or Photocopies NOT Acceptable
This form is for Single persons with no dependents, having wages & interest income only.
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Taxpayer Last Name
First Name
Middle Initial
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Mailing Address (Number & Street, Including Rural Route)
YOU MUST ENTER SSN
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State
Zip
City
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Residence County Code - See Instructions
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See instructions on back of form
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Filing Status
X
X Single
ROUND TO THE NEAREST DOLLAR
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1.
Wages, Salaries, Tips, etc. (Must Attach W-2s)
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Taxable interest income
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3.
Add Lines 1 & 2. This is your Mississippi Adjusted Gross Income.
(P)
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$6,000.00
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This is your exemption.
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$2,300.00
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This is your standard deduction.
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8 3 0 0
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Total of exemption and standard deduction (Lines 4 & 5)
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7.
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Subtract Line 6 from Line 3. This is your taxable income. If Less Than 0, Enter 0.
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Schedule of Tax Computation - Use taxable income from Line 7.
TAX COMPUTATION
TAXABLE INCOME
RATES
INCOME TAX
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8.
$0 - $5,000
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Next $5,000 or part
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10.
Remaining Balance
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11. Total Taxable Income (Add taxable
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income from Lines 8, 9, & 10.)
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TOTAL INCOME TAX (Add Lines 8, 9 & 10.)
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13.
Enter Mississippi income tax withheld. (Must Attach W-2s)
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(W)
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14.
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OVERPAYMENT
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Subtract Line 12 from Line 13
If Line 13 is Larger than Line 12.
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Voluntary Contribution Check-offs (From Form 80-108, Page 1) Enter Total of J, K, L, M, N, Q, and Z in Right Column
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16.
Subtract Line 15 from Line 14
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REFUND
(R)
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Subtract Line 13 from 12, If Line 12 is Larger than Line 13.
BALANCE DUE
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Interest & Penalty (See Instructions)
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TOTAL DUE
Must Attach Check or Money Order for Total Due
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(Add Lines 17 and 18).
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(V)
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payable to: Department of Revenue (ENCLOSE PAYMENT VOUCHER 80-106)
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THIS RETURN MUST BE SIGNED. Under penalties of perjury, I declare that I have examined this return, including accompanying
schedules and statements, and to the best of my knowledge and belief this return is true, correct and complete.
Paid Preparer (Print Firm Name)
Paid Preparer Signature
Taxpayer Signature
PAID PREPARER'S IDENTIFICATION NO. or PTIN
DATE
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Mail REFUND To: Department of Revenue, P.O. Box 23058, Jackson, MS 39225-3058
Mail All Other Returns To: Department of Revenue, P.O. Box 23050, Jackson, MS

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