Form 83-391-12-8-1-000 - Mississippi Insurance Company Income Tax Return - 2012
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4Form 83-391-12-8-1-000 (Rev. 05/12)
MS
Mississippi
Insurance Company Income Tax Return
833911281000
Page 1
2012
Tax Year Beginning
_ _
_ _
_ _ _ _
Tax Year Ending
_ _
_ _
_ _ _ _
m m
d
d
y
y
y
y
m m
d
d
y
y
y
y
Final Return
Amended Return
-
FEIN
__ __
__ __ __ __ __ __ __
Receipts & Disbursements Basis
Check One
Accrual Basis
Fire and Casualty
Life Insurance
Accident and Health
Check One
MS Secretary of State ID
Business Name and DBA
Address
NAICS Code
City
Zip + 4
County Code
State
COMPUTATION OF TAX
1.
Mississippi Net Taxable Income
,
,
,
__ __ __ __ __ __ __ __ __ __
1.
(From Page 2, Line 17, Column 1)
2.
Income Tax
,
,
,
__ __ __ __ __ __ __ __ __ __
2.
3.
Retaliatory Taxes Paid to Other States
,
,
,
__ __ __ __ __ __ __ __ __ __
3.
(MS Corporations Only; From Page 4, Part II, Line 1)
4.
Income Tax Credits
,
,
,
__ __ __ __ __ __ __ __ __ __
4.
(From Form 83-401, Line 3)
5.
Net Income Tax Due
,
,
,
__ __ __ __ __ __ __ __ __ __
(Line 2 Minus Line 3 and Line 4)
5.
PAYMENTS AND TAX DUE
6.
Overpayment from Prior Year
,
,
,
__ __ __ __ __ __ __ __ __ __
6.
7.
Estimated Tax Payments and Payment with Extension
,
,
,
__ __ __ __ __ __ __ __ __ __
7.
8.
Total Payments
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,
,
__ __ __ __ __ __ __ __ __ __
8.
(Line 6 Plus Line 7)
9.
Net Total Income Tax Due
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,
,
__ __ __ __ __ __ __ __ __ __
9.
(Line 5 Minus Line 8; Line 5 is Larger than Line 8)
10. Interest and Penalty on Underestimated Income Tax Payments
10.
,
,
,
__ __ __ __ __ __ __ __ __ __
(From Form 83-305, Line 19)
11.
Late Payment Interest
11.
,
,
,
__ __ __ __ __ __ __ __ __ __
12. Late Payment Penalty
12.
,
,
,
__ __ __ __ __ __ __ __ __ __
13. Late Filing Penalty
13.
,
,
,
__ __ __ __ __ __ __ __ __ __
(Minimum $100)
14. Total BALANCE DUE
14.
,
,
,
__ __ __ __ __ __ __ __ __ __
(If Line 5 is Larger than Line 8, Add Line 9 Plus Line 10 Through Line 13)
15. Total OVERPAYMENT
,
,
,
15.
__ __ __ __ __ __ __ __ __ __
(Line 5 Minus Line 8; Line 8 is Larger than Line 5)
16. Total Overpayment CREDITED to Next Year
16.
,
,
,
__ __ __ __ __ __ __ __ __ __
(From Line 15)
17. Total Overpayment REFUNDED
17.
,
,
,
__ __ __ __ __ __ __ __ __ __
(Line 15 Minus Line 16)
Check Box if Return May Be Discussed with Preparer
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.
Date
Business Phone
Officer Signature and Title
Date
Paid Preparer Address
Paid Preparer Signature
Zip Code
Paid Preparer PTIN
Paid Preparer Phone
City
State
See instructions for electronic payment options or attach Check or Money Order for balance due.
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Parent category: Financial