Form 84-387-14-8-1-000 - Mississippi Partnership Income Tax Withholding Voucher - 2014

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Form 84-387-14-8-1-000 (Rev. 05/14)
Mississippi
Partnership Income Tax Withholding Voucher
Page 1
843871481000
2014
Tax Year Beginning
Tax Year Ending
Estimate Due Date
FEIN
Business Name and DBA
Total number of owners/partners
filed on estimate form(s)
Address
Zip +4
City
State
1 Total partnership net gain or profit
.
1
00
2 5% of net gain or profit withheld (enter the total amount of tax withheld
.
2
and remitted by partnership for owners/partners listed below)
00
OWNER/PARTNER NAME
FEIN
SSN
IDENTIFICATION NUMBER
OWNERSHIP PERCENTAGE
AMOUNT OF PAYMENT
%
3
3
.
00
%
4
4
.
00
%
5
5
.
00
%
6
6
.
00
%
7
7
.
00
%
8
8
.
00
%
9
9
.
00
%
10
10
.
00
%
11
11
.
00
%
12
12
.
00
13
%
13
.
00
14
14 Total of amounts entered on line 3 through line 13
.
00
15 Total amounts from all supplemental pages (Form 84-387, page 2)
15
.
00
16
16 Total estimate payment (add line 14 and line 15; should equal amount of payment/gain entered on line 2)
.
00
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.
Officer/ Agent Signature
Title
Date
Print FEIN on check
Check or money order payable to Department of Revenue
or see instructions for electronic payment options
Mail To: Department of Revenue P.O. Box 23075 Jackson, MS 39225-3075

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