Form 80-360-16-8-1-000 - Catastrophe Savings Tax Schedule

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Form 80-360-16-8-1-000 (Rev. 7/16)
Mississippi
Print Form
Catastrophe Savings Tax Schedule
2016
803601681000
Taxpayer SSN
Spouse SSN
PART I: DEDUCTIBLE LIMITATIONS
1
4
Catastrophe savings account policy
Self-insured (no catastrophe savings policy)
4a
Amount of qualified insurance deductible is (check one):
Value of legal residence
2
.
Less than or equal to $1,000 (enter $2,000 on line 6)
00
3
4b
Limitation (enter lesser of line 4a or $350,000)
Greater than $1,000
3a
.
Amount of deductible
00
.
00
3b
Amount of deductible X 2 (multiply line 3a by two)
.
00
3c
Limitation (enter lesser of line 3b or $15,000)
.
00
PART II: CONTRIBUTIONS
5
.
Total amount of contributions to catastrophe savings account
5
00
Contribution limitation (from line 2 or line 3c (catastrophe savings account) or line 4b
6
.
6
00
(self-insured))
Excess contributions (line 5 minus line 6; enter amount of excess contributions withdrawn on
7
.
7
00
Form 80-108, Part V, Schedule N)
PART III: CALCULATION OF TAX DUE ON DISTRIBUTIONS
8
.
Total amount of distributions from catastrophe savings account
8
00
9
.
Qualified catastrophe expenses
9
00
10
Taxable distributions (line 8 minus line 9; enter amount on Form 80-108, Part V, Schedule N)
.
10
00
Catastrophe savings tax (multiply line 10 by 2 1/2% (.025); enter amount on Form 80-105,
11
.
11
00
line 22 or Form 80-205, line 24; see instructions)

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