Form 80-108-04-5-1-000 - Mississippi Schedule A - Itemized Deductions & Schedule B - Interest & Dividends - 2004 Page 2

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MS
MISSISSIPPI
Other Income (Loss) and Supplemental Income
Page 2
801080452000
2004
1234567897
SSN
Form 80-108-04-5-2-000 (Rev. 6/04)
1234567897
0
0
0
20000
0
0
0
25000
0
0
0
45000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Fo r Computer Use Only - Do Not Write Ab ove This Lin e
PART 4: Income (Loss) from Rents, Royalties, Partnerships, S Corporations, Trusts & Estates
INCOME (LOSS) FROM RENTAL REAL ESTATE AND ROYALTIES
20000
Total Rental Real Estate and Royalty Income (Loss) from Part 1, Federal Schedule E. ( Attach Copy.)
$
25000
Add: Depletion claimed in excess of cost basis
$
45000
A. Rental Real Estate and Royalty Income (Loss) for Mississippi purposes. Add above 2 lines.
$
INCOME (LOSS) FROM PARTNERSHIPS AND S CORPORATIONS
INCOME (LOSS) (Non-residents
Name of Partnership or S Corporation
FEIN
Use Mississippi K-1's)
Total Partnership and/or S Corporation Income (Loss)
B.
$
INCOME LOSS FROM ESTATES AND TRUSTS
INCOME (LOSS) (Non-residents
Name of Estate or Trust
Use Mississippi K-1's)
FEIN
C. Total Estate and Trust Income (Loss)
$
D. Total of lines A, B & C. Enter here and on Line 38, Page 2, Form 80-105 or Line 37
Page2, Form 80-205.(Income From Rents, Royalties, P'ships, S Corps., Trusts, etc.)
$
PART 5: Schedule N - Other Income (Loss) and Supplemental Income
List type of Income or Adjustment
1.
2.
3.
4.
5.
6.
$
Total Schedule N Other Income Or Loss. Enter here and on Line 45, Page 2,
Form 80-105 or Line 44 Page 2, Form 80-205.
$

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