Form 80-105-12-8-1-000 - Mississippi Resident Individual Income Tax Return - 2012

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Form 80-105-12-8-1-000 (Rev. 07/12)
MS
Mississippi
Page 1
Resident Individual Income Tax Return
2012
Amended
801051281000
YOU MUST ENTER SSN
First Name
Middle Initial
Taxpayer Last Name
Middle Initial
__ __ __ - __ __ - __ __ __ __
Spouse First Name
Spouse Last Name
SSN
Spouse
__ __ __ - __ __ - __ __ __ __
Mailing Address (Number & Street, Including Rural Route)
SSN
State
Zip
City
__ __
Residence County Code - See Instructions
Married - Combined or Joint Return
1.
(Enter $12,000 on Line 12.)
7.
Mark "X" ONLY if:
Married - Spouse Died in Tax Year - Enter surviving spouse first as taxpayer
.
Taxpayer Blind
Taxpayer Age 65 or Over
2.
(Enter $12,000 on Line 12. Enter Spouse Name and SSN in boxes provided above.)
Spouse Age 65 or Over
Spouse Blind
Married - Filing Separate Returns
(Enter $12,000 on Line 12. Enter Spouse Name and
3.
__
SSN in boxes provided above. Cannot change from Joint to Separate after due date.)
8. Number of Boxes Marked "X" on Line 7.
Head of Family
(Enter $8,000 on Line 12. Provide Name, SSN, and Relationship of the
4.
9. Number of Dependents Listed on Line 6.
__ __
Dependent Living in the Home with You on Line 6.)
(List additional dependents on Form 80-491)
5.
Single -
(Enter $6,000 on Line 12.)
__ __
10. Total of Line 8 plus Line 9.
Dependents (In column (B) Must enter C for child, P for parent, or R for relative)
6.
(B)
(A) Name
(C) Dependent SSN
__ __, __ __ __.
00
$1,500
11. Line 10 x
___
__ __ __ - __ __ - __ __ __ __
12. Enter Amount from
__ __, __ __ __.
00
Lines 1 through 5.
__ __, __ __ __.
00
___
__ __ __ - __ __ - __ __ __ __
13. Total (Line 11 plus 12).
14. If Filing MFS Returns,
__ __, __ __ __.
00
___
__ __ __ - __ __ - __ __ __ __
Enter 1/2 of Line 13.
If Filing a Combined Return, Use Column A for Taxpayer and Column B for
Round to Nearest Dollar
Column A (Taxpayer)
Column B (Spouse)
Spouse, Otherwise Use Column A ONLY. See instructions in booklet.
15. Wages, Salaries, Tips, etc. (Complete Form 80-107)
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
16. Other Income (Amount from Line 49,
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
Page 2 of this Form)
17. Adjustments to Gross Income (Amount
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
from Line 60, Page 2 of this form)
18. Mississippi Adjusted Gross Income (Line
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
15 plus Line 16 minus Line 17)
19. Standard or Itemized Deductions (For Itemized
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
Deductions , Must Attach Form 80-108)
20. Amount of Exemption Line 13 (Line 14 if
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
Married Filing Separately)
21. Mississippi Taxable Income
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
22. Total Income Tax Due (From Schedule of Tax Computation, Form 80-100)
__, __ __ __, __ __ __.
00
23. Credit for Tax Paid to Another State
__, __ __ __, __ __ __.
00
24. Other Credits (From Form 80-401, Line 1)
__, __ __ __, __ __ __.
00
25. Net Income Tax Due (Line 22 minus Line 23 and 24)
__, __ __ __, __ __ __.
00
26. Consumer Use Tax (See Instructions, Form 80-100)
__, __ __ __, __ __ __.
00
27. Total Tax Due (Line 25 plus Line 26)
__, __ __ __, __ __ __.
00
28. Mississippi Income Tax Withheld (Must Complete Form 80-107)
__, __ __ __, __ __ __.
00
29. Estimated Tax Payments and/or Amount Paid on Original Return
__, __ __ __, __ __ __.
00
30. Total Payments (Line 28 plus Line 29)
__, __ __ __, __ __ __.
00
31. Refund Received And/Or Amount Carried Forward from Original Return (Amended Return Only)
__, __ __ __, __ __ __.
00
32. Overpayment (If Line 30 is larger than Line 27 plus Line 31)
__, __ __ __, __ __ __.
00
33. Overpayment to be Applied to Next Year Estimated Tax Account
__, __ __ __, __ __ __.
00
34. Voluntary Contribution (From Form 80-108, Part 3)
__, __ __ __, __ __ __.
00
35. Refund (Line 32 minus Line 33 and Line 34)
__, __ __ __, __ __ __.
00
36. Balance Due (If Line 27 plus 31 is larger than Line 30)
__, __ __ __, __ __ __.
00
__, __ __ __, __ __ __.
00
37. Interest and Penalty (Including Interest on Underpayment of Estimated Tax, Form 80-320)
38. Total Due (Line 36 plus Line 37)
__, __ __ __, __ __ __.
00
Duplex and Photocopies NOT Acceptable

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