Form Ms8453-Pte - Pass - Through Entity Declaration For Electronic Filing - 2014

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Form 84-115-14-8-1-000 Rev. (05/14)

Print Form

Mississippi

MS8453-PTE

Pass - Through Entity Declaration for Electronic Filing

2014

Tax Year Beginning

Tax Year Ending

DO NOT MAIL THIS DOCUMENT

FEIN

TO THE DEPARTMENT OF REVENUE

Legal Name and DBA

Address

City

State

Zip +4

County Code

PART I: TAX RETURN INFORMATION

(ROUND TO THE NEAREST DOLLAR)

1 Mississippi taxable income (Form 84-105, line 5)

2 Total income tax (Form 84-105, line 6)

3 Total payments & credits (Form 84-105, line 7 and line 12)

4 Amount you owe (Form 84-105, line 18)

5 Overpayment (Form 84-105, line 19)

6 Refund (Form 84-105, line 21)

7 Amount of payment remitted electronically

* If the pass-through entity is filing a balance due return and the Department of Revenue does not receive full and timely payment of its tax liability,

the pass-through entity will be liable for the tax liability and all applicable interest and penalties.

PART II: DECLARATION OF OFFICER

Under the penalties of perjury, I declare that I am an officer of the above pass-through entity and that the information I have given my electronic return originator (ERO),

transmitter, and/or intermediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding lines of the pass-through entity's

Mississippi Pass-Through Entity Tax Return. To the best of my knowledge and belief, the pass-through entity's return is true, correct and complete. I consent to my ERO,

transmitter, and/or ISP sending the pass-through entity's return, this declaration, and accompanying schedules and statements to the Department of Revenue (DOR). I also

consent to the DOR my ERO, transmitter, and/or ISP an acknowledgement of receipt of transmission and an indication of whether or not the pass-through entity's return is

accepted, and, if rejected, the reason(s) for the rejection. This declaration is to be maintained by the ERO and provided to DOR on request.

Sign

Signature of Officer

Date

Title

Here

PART lll: DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER

I declare that I have reviewed the above pass-through entity's return and that the entries on Form MS8453-PTE are complete and correct to the best of my knowledge. If I am

only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The corporate officer will have signed

this form before I submit the return. I will give the officer a copy of all forms and information to be filed with the Department of Revenue (DOR), and have followed all other

requirements in Pub. 3112, IRS e-file Application and Participation and Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers. If I am also the

Paid Preparer, under penalties of perjury, I declare that I have examined the above pass-through entity's return and accompanying schedules and statements, and to the best

of my knowledge and belief, they are true, correct and complete. This Paid Preparer declaration is based on all information of which I have any knowledge.

ERO Signature

Date

Check if Also

Check if Self-

ERO

ERO SSN or PTIN

Paid Preparer

Employed

Use

Only

Firm Name (or yours if

EIN

self-employed), address and

ZIP code

Phone No. (

)

Under penalties of perjury, I declare that I have examined the above pass-through entity's return and accompanying schedules and statements, and to the best of my

knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

Preparer Signature

Date

Check if Also

Check if Self-

Preparer SSN or PTIN

Paid

Paid Preparer

Employed

Preparer

Use Only

Firm Name (or yours if