Form 84-387-12-8-1-000 - Mississippi Partnership Income Tax Withholding Voucher

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Mississippi
Form 84-387-12-8-1-000 (Rev. 05/12)
MS
Partnership Income Tax Withholding Voucher
843871281000
Page 1
Tax Year Beginning
__ __
__ __
__ __ __ __
Tax Year Ending
__ __
__ __
__ __ __ __
m
m
d
d
y
y
y
y
m
m
d
d
y
y
y
y
-
FEIN
__ __
__ __ __ __ __ __ __
Estimate Due Date
__ __
__ __
__ __ __ __
m
m
d
d
y
y
y
y
Business Name and DBA
Total
Number of Owners / Partners
Filed on Estimate Form(s)
Address
__ __ __ __
City
Zip +4
State
1. Total Partnership Net Gain or Profit
,
__ __ __ __ __ __ __ __ __ __
,
,
2. 5% of Net Gain or Profit Withheld
__ __ __ __ __ __ __ __ __ __
,
,
,
Enter the Total Amount of Tax Withheld and Remitted by Partnership for Owners / Partners Listed Below.
FEIN SSN
Owner / Partner Name
Identification Number
Amount of Payment
Ownership Percentage
.
3.
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__ __ __ __ __
%
,
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,
,
.
__ __ __ __ __
%
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4.
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,
.
__ __ __ __ __ __ __ __ __
5.
__ __ __ __ __
%
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.
6.
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__ __ __ __ __
%
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,
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.
__ __ __ __ __ __ __ __ __
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%
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7.
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__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
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,
8.
,
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.
__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
9.
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__ __ __ __ __ __ __ __ __
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%
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10.
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,
.
__ __ __ __ __ __ __ __ __
11.
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%
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,
,
.
__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
12.
,
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__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
13.
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14.
__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
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15.
__ __ __ __ __ __ __ __ __
__ __ __ __ __
%
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,
,
.
16.
__ __ __ __ __
%
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,
__ __ __ __ __ __ __ __ __ __
,
,
17.
Total of Amounts Entered on Lines 3 Through 16
,
__ __ __ __ __ __ __ __ __ __
,
,
18.
Total Amounts From All Additional Pages
,
__ __ __ __ __ __ __ __ __ __
,
,
(Form(s) 84-387, Page 2)
19.
Total Estimate Payment
,
__ __ __ __ __ __ __ __ __ __
,
,
(Add Lines 17 and 18. Should Equal Amount of Payment / Gain
Entered on Line 2)
I declare, under penalties of perjury, that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, this is a true,
correct and complete return.
Officer/ Agent Signature
Title
Date
•
Duplex or Photocopies NOT Acceptable
Mail To:
Department of Revenue
•
Print FEIN on Check
P.O. Box 23075
•
Check or money order payable to Department of Revenue
or see instructions for electronic payment options.
Jackson, MS 39225-3075

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