Form 83-180-13-8-1-000 - Application For Automatic Six Month Extension - 2013 Page 2

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Form 83-180-13-8-2-000 (Rev. 09/13
Mississippi
Application for Automatic Six-Month Extension
831801382000
Page 2
2013
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NAME
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SSN
IDENTIFICATION NUMBER
AMOUNT OF PAYMENT
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Subtotal (add lines and enter total amount on Form 83-180, line 17)
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Supplemental Page ____ of ____

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