Form 80-120-99-8-1-000 - Telefile Signature Document Individual Income Tax Return - 1999

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Mississippi
Form 80-120-99-8-1-000 Rev. (12/99)
TELEFILE SIGNATURE DOCUMENT
WIT
Individual Income Tax Return
1999
MS 8453 - TELEFILE
Photocopies are NOT Acceptable
Last Name
Your First Name & Middle Initial
Spouse's Name & Middle Initial
Your
SSN
Mailing Address (Number & Street, Including Rural Route)
Residence
Spouse
County Code -
SSN
See Instructions
State
ZIP
City or Town
Your Occupation
Spouse's Occupation
You have not filed a complete
See instructions on the back of this page. Round amounts to the nearest dollar.
return by telephone until this signed document is received by the State Tax Commission.
1. Enter name, address, social security number, and county code in the label area above. See Page 2 for a listing of
county codes.
2. Attach W-2 forms with this return.
Whole Dollars Only
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3. Enter refund amount
REFUND
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4. If you owe state income tax, enter the amount due in the box. Attach check or
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(V)
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money order for the total due payable to: STATE TAX COMMISSION
TOTAL DUE
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5. Sign the return below.
6. If you completed the Telefile Worksheet during your TELEFILE call, DO NOT send the Worksheet to the
State Tax Commission. Keep the Worksheet for your records.
7. Send this form with W-2 form(s) [and payment if applicable] to the appropriate address below.
THIS RETURN MUST BE SIGNED. Under penalties of perjury, I declare that correct information to the best of my ability was given through the Telefile
Telephone Tax System in filing my 1999 return. I understand that my income tax return is not complete until this Signature Document is received by the
State Tax Commission. To the best of my knowledge and belief, my return is true, correct and complete. This declaration must be forwarded to the State
Tax Commission as validation of my Telephone Filed Income Tax Return.
Taxpayer Signature
Date
Spouse's Signature
Date
Mail REFUND To:
Office of Revenue, P.O. Box 23058, Jackson, MS 39225-3058
Mail All Other Returns To:
Office of Revenue, P.O. Box 23050, Jackson, MS 39225-3050

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