Mississippi Amended Nonresident Or Part-Year Resident Individual Income Tax Return - 2004

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Mississippi
Amended
MS
Nonresident or Part-Year Resident
For Official Use Only
Individual Income Tax Return
IS A
802700451000
2004
Page 1 of 2
Form 80-270-04-5-1-000 (Rev. 05/04)
6A
RC
11
15A
18A
22
25
DS1
6B
FS
12
15B
19A
23
26
DS2
6C
8
13
15C
20A
24
27
DS3
6D
9
14
16A
21A
25A
28
DS4
7A
10
16B
18B
25B
29
TS
7B
17A
19B
25C
30
SS
7C
17B
20B
25D
31
TY
7D
21B
32
PS
N3
N1
N2
N6
N4
N5
A
For Computer Use Only - Do Not Write Above This Line
C1
C2
C3
1.
Married - Combined or Joint Return - Enter $12,000 on Line 12.
2.
Married - Spouse Died in 2002 - Enter $12,000 on Line 12.
Taxpayer SSN
Married - Filing Separate Returns - Enter $12,000 on Line 12. Enter Spouse name above.
3.
Spouse SSN
Head of Family - Enter $8000 on Line 12. Provide Name, SSN, and
4.
County Code
Relationship of the Dependent Living in the Home with You on Line 6.
5.
Single - Enter $6,000 on Line 12.
8.
Number of Dependents Listed on Line 6
8.
Dependents (Do NOT Claim Yourself or Your Spouse)
9.
Number of Boxes Marked "X" on Line 7
9.
6.
(a) Name
(b) Dependent SSN
(c) Relationship
10.
Total of Line 8 plus Line 9.
10.
$ 1,500
=
Line 10 x
11.
11.
12.
Enter Amount from Lines 1-5.
12.
13. Total (Line 11 plus 12).
13.
14. If Married-Filing Separate Returns,
Taxpayer Age
Taxpayer
Spouse Age
Spouse Blind
7. Mark "X" if
14.
Enter 1/2 of Line 13.
65 or Over
Blind
65 or Over
Complete Schedule of Income on Page 2 Before Proceeding Further. The Exemption and Deduction (standard or itemized) must be prorated according to the ratio of
Mississippi Income to Total Income of Taxpayer and Spouse from all sources.
Round All Amounts to the Nearest Dollar
15.
Ratio Computation
17.
Exemption Computation
16.
Standard or Itemized Deduction
15a.
MS AdjustedGross Income
17a.
16a.
Standard or Itemized Deduction
Exemption, Line 13 above. (Line 14 if MFS)
15b.
Total Adjusted Gross Income From All Sources
17b.
MS Exemption Multiply 17a by 15c
16b.
MS Deduction- Multiply 16a by 15c
(N)
15c.
%
Column A (Taxpayer)
Column B (Spouse)
Ratio: Line 15a divided by Line15b
(P)
(B)
18.
18.
Mississippi Adjusted Gross Income (From line 54 or line 55 Page 2.)
(F)
(H)
19.
Standard or Itemized Deductions (Line 16b)
19.
20.
Amount of Exemption (Line 17b)
20.
Mississippi Taxable Income (Line 18 minus Lines 19 and 20.)
21.
21.
See Instructions. If less than 0, enter 0.
22.
Total Income Tax Due.
22.
(W)
23.
Mississippi Income Tax Withheld (Attach W-2s.)
23.
Estimated Tax Payments, Amount Paid with Extension and Amount Paid with Original Return less amount of
(E)
24.
24.
Overpayment (Line 27 original return).
(O)
25.
25A
25B
25.
25C
25D
Other Credits (See instructions) Enter code for each type of credit claimed.
26.
Overpayment from original return
26.
27.
Total Credits (Add Lines 23 through 25 less Line 26.)
27.
28.
28.
(R)
Enter the Amount of Refund if Line 27 is Larger than Line 22.
REFUND
29.
Enter Balance Due if Line 22 Is Larger Than Line 27.
29.
BALANCE DUE
30.
Interest on Underpayment of Estimated Tax Payments
30.
(I)
31.
Interest and Penalty (See Instructions)
31.
(T)
TOTAL DUE (Add Lines 29, 30, and 31.) Attach Check or Money Order for Total Due payable to:
32.
(V)
32.
TOTAL DUE
State Tax Commission
>ENCLOSE PAYMENT VOUCHER 80-106<
PLEASE SIGN THIS TAX RETURN IN THE SIGNATURE AREA PROVIDED ON THE BOTTOM OF PAGE 2

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