Form 83-450-12-8-1-000 - Mississippi New Jobs Credit

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Mississippi
Form 83-450-12-8-1-000 (Rev. 05/12)
New Jobs Credit
Page 1
For Period Ending:
__ __
__ __
__ __ __ __
m
m
d
d
y
y
y
y
County:
Name of Entity
-
FEIN
Facility
__ __
__ __ __ __ __ __ __
Location:
1. For each month, list the number of full time employees subject to Mississippi withholding, at this facility at the end of each month.
______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
Month
Base Year
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2. Total Employees
3. Number of Months
in Operation
4. Average of Full-
Time Employees
5. Less Prior Year Average
6. Average Increase in Full-Time
Employees
(Enter also on page 2, line 7)
6a. Number of New Jobs Eligible for Percentage of
Payroll(Enter also on Page2, line21)*
* Determine number of New Jobs eligible for percentage of payroll within one (1) year. Attach a schedule listing new full-time jobs
created (title, date created and payroll amount for each year).
(Continued on page 2)

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