Form 83-391-11-8-1-000 - Mississippi Insurance Company Income Tax Return - 2011
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4Mississippi
Form 83-391-11-8-1-000 (Rev. 08/11)
Insurance Company Income Tax Return
2011
833911181000
Page 1
Tax Year Ending
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Tax Year Beginning
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m
m
d
d
y
y
y
y
m
m
d
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y
Final Return
Amended Return
Accrual Basis
FEIN
Receipts & Disbursements Basis
Life Insurance
Accident and Health
Fire and Casualty
Business Name and DBA
MS SOS ID
Address
NAICS Code
City
Zip + 4
County Code
State
COMPUTATION OF TAX
1.
Mississippi Net Taxable Income
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1.
(From Page 2, Line 17, Column 1)
2.
Income Tax
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2.
3.
Retaliatory Taxes Paid to Other States
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3.
(MS Corporations Only; From Page 4, Part II, Line 1)
4.
Income Tax Credits
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4.
(From Form 83-401, Line 3)
5.
Net Income Tax Due
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(Line 2 Minus Line 3 and Line 4)
5.
PAYMENTS AND TAX DUE
6.
Overpayment from Prior Year
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6.
7.
Estimated Tax Payments and Payment with Extension
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7.
8.
Total Payments
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8.
(Line 6 Plus Line 7)
9.
Net Total Income Tax Due
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9.
(Line 5 Minus Line 8; Line 5 is Larger than Line 8)
10.
Late Payment Interest
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10.
11. Late Payment Penalty
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11.
12. Late Filing Penalty
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12.
(Minimum $100)
13. Total BALANCE DUE
(If Line 5 is Larger than Line 8, Add Line 9 Plus Line 10 Through Line 12)
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13.
Attach Payment Voucher, Form 83-300, with Check or Money Order for Balance Due,
or See Instructions for Electronic Payment Options.
14. Total OVERPAYMENT
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(Line 5 Minus Line 8; Line 8 is Larger than Line 5)
14.
15. Total Overpayment CREDITED to Next Year
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(From Line 14)
15.
16. Total Overpayment REFUNDED
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(Line 14 Minus Line 15)
16.
Check Box if Return May Be Discussed with Preparer
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 Signature and Title
Date
Business Phone
Paid Preparer Signature
Date
Paid Preparer Address
Paid Firm Identification Number
Paid Preparer PTIN
Preparer Phone
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