Form 84-387-13-8-1-000 - Partnership Income Tax Withholding Voucher - 2013

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Form 84-387-13-8-1-000 (Rev. 09/13)
Print Form
Mississippi
Partnership Income Tax Withholding Voucher
Page 1
843871381000
2013
Tax Year Beginning
Tax Year Ending
m m d d
y y y y
m m d d
y y y y
Estimate Due Date
FEIN
m m d d
y y y y
Business Name and DBA
Total number of owners/partners
filed on estimate form(s)
Address
_________
City
  State
Zip +4
1 Total partnership net gain or profit
1
.00
_____________________________
2 5% of net gain or profit withheld (enter the total amount of tax withheld
2
.00
_____________________________
and remitted by partnership for owners/partners listed below)
OWNER/PARTNER NAME
FEIN
SSN
IDENTIFICATION NUMBER
OWNERSHIP PERCENTAGE
AMOUNT OF PAYMENT
3
____ . _______
%
3
.00
_____________________________
4
____ . _______
%
4
.00
_____________________________
5
____ . _______
%
5
.00
_____________________________
6
____ . _______
%
6
.00
_____________________________
7
____ . _______
%
7
.00
_____________________________
8
____ . _______
%
8
.00
_____________________________
9
____ . _______
%
9
.00
_____________________________
10
____ . _______
%
10
.00
_____________________________
11
____ . _______
%
11
.00
_____________________________
12
____ . _______
%
12
.00
_____________________________
13
____ . _______
%
13
.00
_____________________________
14 Total of amounts entered on line 3 through line 13
14
.00
_____________________________
15 Total amounts from all additional pages (Form 84-387, page 2)
15
.00
_____________________________
16 Total estimate payment (add line 14 and line 15; should equal amount of payment/gain entered on line 2)
16
.00
_____________________________
I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief,
this is a true, correct and complete return.
Officer/ Agent Signature
Title
Date
Duplex or photocopies NOT acceptable
Print FEIN on check
Check or money order payable to Department of Revenue
or see instructions for electronic payment options
Mail To: Department of Revenue P.O. Box 23075 Jackson, MS 39225-3075

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