Form 80-300-99-3-1-000 - Estimated Tax Declaration For Individuals - Voucher 4 - 1999 Page 5

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Mississippi
MS
IE
Voucher 4
Estimated Tax Declaration for Individuals -
January 15, 2000
This Payment Due Date
Form 80-300-98-3-1-000 (Rev. 8/97)
803009931000
Your Social Security Number
Spouse's Social Security Number
Check Box if Fiduciary Return
54/9
1999
16/11to25/11
38/11to47/11
N
15/13to34/13
37/13to48/13
51/13to62/13
A
Total amount of this installment
15/15to42/15
30/17
C
15/17to26/17
35/17to43/17
67/17to75/17
to
31/17
Mail to:
Bureau of Revenue
Return this voucher with check
Print Social Security Number
P. O. Box 23075
or money order payable to
on check - Spouse's
State Tax Commission
if JOINT ACCOUNT
Jackson, MS 39225-3075
The beginning and ending positions of each data box above is referenced in the box.

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