Form 80-105-14-8-1-000 - Mississippi Resident Individual Income Tax Return - 2014 Page 2

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Mississippi
Page 2
Form 80-105-14-8-2-000 (Rev. 5/14)
Resident Individual Income Tax Return
2014
801051482000
SSN
INCOME
Column A (Taxpayer)
Column B (Spouse)
.
.
36
Wages, salaries, tips, etc. (complete Form 80-107)
36A
36B
00
00
37
Business income (loss) (attach Federal Schedule C or C-EZ)
.
.
37A
37B
00
00
.
.
38
Capital gain (loss) (attach Federal Schedule D)
38A
38B
00
00
39
Rent, royalties, partnerships, S corporation trusts, etc.
(from Form 80-108, part IV)
.
.
39A
39B
00
00
.
.
40
Farm income (loss) (attach Federal Schedule F)
40A
40B
00
00
41
Interest income (from Form 80-108, part II, line 3)
.
.
41A
41B
00
00
.
.
42
Dividend income (from Form 80-108, part II, line 6)
42A
42B
00
00
.
.
43
Alimony received
43A
43B
00
00
.
.
44
Taxable pensions and annuities (complete Form 80-107)
44A
44B
00
00
.
.
45
Unemployment compensation (complete Form 80-107)
45A
45B
00
00
46
Other income (loss) (from Form 80-108, part V, line 10)
.
.
46A
46B
00
00
.
.
47
Total income (add lines 36 through 46)
47A
47B
00
00
ADJUSTMENTS
Column A (Taxpayer)
Column B (Spouse)
48
Payments to IRA
.
.
48A
48B
00
00
.
.
49
Payments to self-employed SEP, SIMPLE and qualified retirement plans
49A
49B
00
00
.
.
50
Interest penalty on early withdrawal of savings
50A
50B
00
00
.
.
51
Alimony paid (complete below)
51A
51B
00
00
Name
SSN
State:
Name
SSN
State:
Name
SSN
State:
.
.
52
Moving expense (attach Federal Form 3903)
52A
52B
00
00
53
National Guard or Reserve pay (enter the lesser of amount or $15,000)
.
.
53A
53B
00
00
.
.
54
Mississippi Prepaid Affordable College Tuition (MPACT)
54A
54B
00
00
55
Mississippi Affordable College Savings (MACS)
.
.
55A
55B
00
00
.
.
56
Self-employed health insurance deduction
56A
56B
00
00
.
.
57
Health savings account deduction
57A
57B
00
00
58
Total adjustments (add lines 48 through 57)
.
.
58A
58B
00
00
59
Mississippi adjusted gross income (line 47 minus line 58; enter
.
.
on page 1, line 13)
59A
59B
00
00
AMENDED RETURN - EXPLANATION OF CHANGES TO ORIGINAL RETURN (attach additional statement if needed)
This return may be discussed with the preparer
Yes
No
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. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Taxpayer Signature
Date
Taxpayer Phone Number
Paid Preparer PTIN
Spouse Signature
Date
Paid Preparer Email Address
Paid Preparer Phone Number
Date
Paid Preparer Signature
Paid Preparer Address
City
State
Zip Code
Mail REFUND returns to: Department of Revenue, P.O. Box 23058, Jackson, MS 39225-3058
Mail all other returns to: Department of Revenue, P.O. Box 23050, Jackson, MS 39225-3050
Duplex and Photocopies NOT Acceptable

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