Form 89-140 - Annual Information Return - 2004

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MISSISSIPPI
ANNUAL INFORMATION RETURN
CALENDAR YEAR 2004
Form 89-140
Rev. 11/04
ROUTE TO WITHHOLDING
KEE P WITH W2's OR 1099's
Name
FEIN
-
A ddress
Magnetic
Media Reporting Method:
City
State
Zi p
Paper
ADDRESS CHANGE - Check box and write the new address in the area above.
Corrected Annual Information Return.
CLOSE ACCOUNT - To close the account, check the "CLOSE ACCOUNT" check box and attach a statement regarding the
disposition of the business. The statement should include details such as if the business was sold; to whom it was sold;
effective dates of closure; if, or when, the business will reopen, etc.
,
1. Number of accompanying information returns.
Information return category:
W-2
W-2C
W-2G
1099
FOR EACH CATEGORY, A SEPARATE FORM 89-140 MUST BE SUBMITTED
,
,
.
00
2.
Total Mississippi wages or compensation for the calendar year.
,
,
.
00
3. Total Mississippi income tax withheld.
,
,
.
00
4. Total tax remitted for the year.
Do not include interest and penalty in this amount.
If lines 3 and 4 are not the same, see instructions on the back of this form.
Do not send payment with this form. Credit will not be applied to your account if you submit payment with this form.
Amended or additional returns must be filed for any underpayment or overpayment.
S ignature
Phone
Date
(
)
S ubmitting Company (If differ ent from a bove)
Submittin g Compan y Phon e
(
)
Contact P erson
Addre ss

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