Form 83-105-13-8-1-000 - Corporate Income And Franchise Tax Return - 2013 Page 3

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Form 83-105-13-8-3-000 (Rev. 09/13)

Mississippi

Corporate Income and Franchise Tax Return

831051383000

2013

Page 3

FEIN

PART lII: CORPORATE AFFILIATION SCHEDULE

List all entities owned by and affiliated with the corporation. See page 4 for additional schedule if needed.

ENTITY NAME

FEIN

ADDRESS

ENTITY TYPE

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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Officer Signature and Title

Date

Business Phone

Paid Preparer Signature

Date

Paid Preparer Address

City

State

Zip Code

Paid Preparer PTIN

Paid Preparer Phone

Mail Return To: Department of Revenue P.O. Box 23050 Jackson, MS 39225-3050