Form 89-142-11-8-1-000 - Annual 1099 Information Return Calendar Year 2011 - Mississippi Department Of Revenue

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Form 89-142-11-8-1-000 Rev. 11/11
MISSISSIPPI
MS
ANNUAL 1099 INFORMATION RETURN
CALENDAR YEAR 2011
891421181000
Duplex and Photocopies NOT acceptable
Must be completed
Name
FEIN
Address
The FEIN above must match the State's account
number into which the payments have been made. If
not, see instructions on the back of this form or on our
website.
STATE
City
State
Zip
EIN
Leave empty if same as FEIN
Information Returns:
Select Method of Filing:
1099-INT
1099-A
See IRS Pub 1220 File Layout
Check All Appropriate Boxes
Electronic - Diskette or
1099-K
1099-B
CD attached
1099-MISC
1099-C
Paper Returns (49 or fewer)
1099-R
Filed via Combined Federal
1099-DIV
1099-PATR
Other Returns W-2G, 1042-S
/State Filing (CF/SF) Program
showing Mississippi Income
No Mississippi Withholding
Tax Withheld OR any other
1099-S
Other
return
showing MS
(non-wage)
withholding.
Paying Late Filing Penalty - Previously Filed Returns (No attachments)
A SEPARATE FORM 89-142 MUST BE SUBMITTED FOR EACH TYPE OF RETURN
Electronic upload of these files is possible this year. Visit for instructions on using
our secure portal. If you upload a file, this paper Form 89-142 is not required.
1.
Number of accompanying returns. (Actual Number of Returns) ................
.
2. Total Mississippi income/receipts for the calendar year .....................................
00
.
00
3.
Total Mississippi income tax withheld by category checked above..........
.
4. Total tax remitted for 2011 tax year by category checked above.........................
00
Do not include interest and penalty in this amount.
.
Penalty due to late filing or incorrect filing method: The greater of $250
5.
00
or $5 per informational return issued (line 1 multiplied by $5).........................
Submitting of 50 or more informational returns is required to be in an electronic format. Failure to submit electronically will subject
the reporting entity to a penalty. Most informational returns are required to be submitted by March 15, however, paper filed
1099-R's are due by January 31 and electronically filed 1099-R's by February 28. Failure to submit the returns timely will subject the
entity to a penalty. This penalty is provided on line 5 above.
Only Penalty payments are permitted to accompany this form. Do not send a tax payment with this form. Credit will
not be applied to your account if payment is submitted with this form. Amended or additional paper Form 89-105 returns must be
filed for any underpayment or overpayment. To request a PDF of the Form 89-105, send an email request to
Phone + Extension
Signature
Date Signed
(
)
Ext
Submitting Company (If different from above)
Submitting Company Phone + Extension
Date Mailed
(
)
Ext
Address
Contact Person (Please Print)
Mail to:
Department of Revenue
Withholding Tax Division
P. O. Box 960
Jackson, MS 39205-0960

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