Form 80-105-98-5 - Resident Individual Income Tax Return - 1998 Page 8

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Mississippi
MS
Resident Individual Income Tax Return
1998
Your SSN
801059852000
321-45-6789-3
Page 2 of 2
Form 80-105-98-5-2-000 (Rev. 7/97)
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-3000
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N
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For Computer Use Only
Do Not Write Above This Line
To show a loss, place a minus (-) in front of the dollar amount.
SCHEDULE OF INCOME.
Column A (Taxpayer)
Column B (Spouse)
39.
Interest Income (Attach Schedule B if over $1,000).......................................................
40.
Dividend Income (Attach Schedule B if over $1,000)....................................................
41.
Alimony Received................................................................................................................
-3,000
42.
Business Income or Loss (Attach Federal Schedule C or C-EZ).................................
43.
Capital Gain or Loss (Attach Federal Schedule D). See Instructions.........................
Pensions and Annuities. (See Instructions)
44.
Taxable
Amount
Total Taxpayer
Total Spouse
45.
Farm Income or Loss (Attach Federal Schedule F)........................................................
46.
Unemployment Compensation (Form(s) 1099-G)...........................................................
47.
Other Income or Loss (Attach Federal Schedule E and/or Mississippi Schedule N)..............
-3,000
48.
Total Income (Add Lines 38 through 47. Carry Amounts to Page 1, Line 17).......
SCHEDULE OF ADJUSTMENTS TO GROSS INCOME
49.
Payments to an IRA and/or a SEP....................................................................................
50.
Payments to KEOGH (HR10) Retirement Plan................................................................
51.
Interest Penalty on Early Withdrawal of Savings............................................................
52.
Alimony Paid (Complete Schedule P)..............................................................................
53.
Moving Expense (Attach Federal Form 3903 or 3903F)...............................................
54.
National Guard or Reserve Pay (Enter the Lesser of the
Guard Pay or the $5,000 Statutory Exclusion Per Taxpayer).....................................
55.
Mississippi Prepaid Affordable College Tuition (MPACT)............................................
56.
Total Adjustments (Add Amounts for Lines 49 through 55.
Carry Amounts to Page 1, Line 18)..................................................................................
SSN of Recipient
SCHEDULE P - ALIMONY PAID
If a deduction is claimed for Alimony Paid, must furnish the
name, SSN, and state of residency of the individual to whom
State of Residency
Name
the amount was paid.
THIS RETURN MUST BE SIGNED. Under penalties of perjury, I declare that I have ex amined this return, including accompanying schedules and statements,
and to the best of my knowledge and belief it is true, correct and complete.
Your Signature
Paid Firm's Identification Number
Taxpayer's Phone
Spouse's Signature (If joint, BOTH must sign)
Date
Paid Preparer's Social Security Number
Paid Preparer's Signature
Date
Paid Preparer (Print Firm's Name)
Paid Preparer's Phone
Paid Preparer's Address
Mail TAX DUE To: Bureau of Revenue, P.O. Box 23050, Jackson, MS 39225-3050
Mail REFUND To: Bureau of Revenue, P.O. Box 23058, Jackson, MS 39225-3058

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