Form 80-300-00-9-1-000 - Estimated Tax Declaration For Individuals - Voucher 4 - State Of Mississippi - 2000 Page 2

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Mississippi
Voucher 1
Estimated Tax Declaration for Individuals -
WIE
April 15, 2000
This Payment Due Date
Photocopies NOT Acceptable
803000091000
Form 80-300-00-9-1-000 (Rev. 4/99)
2000
Your Social Security Number
Spouse's Social Security Number
Check Box if Fiduciary Return
Last Name
Spouse's First Name and Middle Initial
First Name and Middle Initial
Whole Dollars Only
Mailing Address (Number and Street, including Rural Route)
Total amount of this installment
City
State
Zip
Print Social Security Number
on check - Spouse's
Mail to:
Return this voucher with
if JOINT ACCOUNT.
Office of Revenue
check or money order payable
P. O. Box 23075
to State Tax Commission.
Jackson, MS 39225-3075
Cut Along Line

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