Mississippi
Form 83-105-12-8-3-000 (Rev. 05/12)
Corporate Income and Franchise Tax Return
MS
2012
Page 3
831051283000
FEIN
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SUPPLEMENTAL CORPORATE AFFILIATION SCHEDULE
List all entities owned by and affiliated with the corporation. Continued from page 2, part III.
Entity Name
FEIN
Address
Entity Type
Additional Page ____ of ____