Form 83-115-12-8-1-000 - Mississippi Corporate Income Declaration For Electronic Filing - 2012

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Mississippi
Form 83-115-12-8-1-000 Rev. (05/12)
Corporate Income
Declaration for Electronic Filing
2012
MS8453-C
For Calendar Year 2011, or Tax Year Beginning
, Ending
, 20
IRS DECLARATION CONTROL NUMBER
00-
Duplex or Photocopies NOT Acceptable
Name
FEIN
Mailing Address (P O Box or Street Including Rural Route)
(See Instructions)
City
State
Zip +4
County Code
DO NOT MAIL THIS DOCUMENT TO THE DOR
ELECTRONIC RETURN ORIGINATOR (ERO) RETAIN THIS FORM IN YOUR FILES
PART I:
TAX RETURN INFORMATION (Round to the Nearest Dollar)
Mississippi Taxable Income (Form 84-105, Line 5)
,
,
,
1.
1.
__ __ __ __ __ __ __ __ __ __
............... .......................
,
Total Income Tax (Form 84-105, Line 6)
,
,
2.
2.
__ __ __ __ __ __ __ __ __ __
. .......................................................
,
Total Payments & Credits (Form 84-105, Line 7 and Line 12)
,
,
3.
3.
__ __ __ __ __ __ __ __ __ __
,
Amount You Owe (Form 84-105, Line 18)
,
,
4.
4.
__ __ __ __ __ __ __ __ __ __
.. ............................................. ..
,
5.
,
,
Overpayment (Form 84-105, Line 19)
5.
__ __ __ __ __ __ __ __ __ __
..................................................
,
,
,
6.
Refund (Form 84-105, Line 21)
6.
__ __ __ __ __ __ __ __ __ __
.............. ...................................... .....
,
,
,
7.
Amount of Payment Remitted Electronically
7.
__ __ __ __ __ __ __ __ __ __
. ....................................... . ..
* If the corporation is filing a balance due return and the Department of Revenue does not receive full and timely payment of its tax liability, the
corporation will be liable for the tax liability and all applicable interest and penalties.
PART II:
DECLARATION OF OFFICER (See Instructions)
Under the penalties of perjury, I declare that I am an officer of the above corporation and that the information I have given my electronic return
originator (ERO), transmitter, and/or intermediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding
lines of the corporation's Mississippi Corporate Income & Franchise Tax Return. To the best of my knowledge and belief, the corporation's return is
true, correct and complete. I consent to my ERO, transmitter, and/or ISP sending the corporation's return, this declaration, and accompanying
schedules and statements to the Department of Revenue (DOR). I also consent to the DOR my ERO, transmitter, and/or ISP an acknowledgement of
receipt of transmission and an indication of whether or not the corporation's return is accepted, and, if rejected, the reason(s) for the rejection. This
declaration is to be maintained by the ERO and provided to DOR on request.
Sign
Signature of Officer
Title
Date
Here
lll:
PART
DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER (See Instructions)
I declare that I have reviewed the above corporation's return and that the entries on Form MS8453-C are complete and correct to the best of my
knowledge. If I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the
return. The corporate officer will have signed this form before I submit the return. I will give the officer a copy of all forms and information to be filed
with the Department of Revenue (DOR), and have followed all other requirements in Pub. 3112, IRS e-file Application and Participation and Pub. 4163,
Modernized e-File (MeF) Information for Authorized IRS e-file Providers. If I am also the Paid Preparer, under penalties of perjury, I declare that I have
examined the above corporation's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct and complete. This Paid Preparer declaration is based on all information of which I have any knowledge.
Check if Also
Check if Self-
ERO's SSN or PTIN
Date
Paid Preparer
Employed
ERO's Signature
ERO'S
Firm's Name (or your's if Self-
EIN
Use
Only
employed), address and ZIP code
Phone No. (
)
Under penalties of perjury, I declare that I have examined the above corporation's return and accompanying schedules and statements, and to the best
of my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.
Date
Check if Also
Check if Self-
Preparer's SSN or PTIN
Paid Preparer
Employed
Preparer's Signature
Paid
Firm's Name (or your's if Self-
EIN
Preparer's
employed), address and ZIP code
Use Only
Phone No. (
)
DO NOT MAIL THIS DOCUMENT TO THE DEPARTMENT OF REVENUE

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