Request For Tax Transcript - Mississippi State Tax Commission
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1Individual Income Tax Division
Tax Transcript Request
1577 Springridge Road
Post Office Box 22808
MISSISSIPPI
Raymond, MS 39154
Jackson, MS 39225-2808
STATE TAX COMMISSION
REQUEST FOR TAX TRANSCRIPT
I would like to request a tax transcript certifying that I filed Mississippi State Income Tax Returns for the last four years.
FULL NAME:
__________________________________________
ADDRESS:
__________________________________________
CITY, STATE, ZIP CODE:
__________________________________________
SOCIAL SECURITY NUMBER:
_______-______-__________
SIGNATURE:
________________________________
DATE: ____________
In order to process this request, you must provide the following information for each tax year requested:
Tax year
Filing Status*
Full Legal Name of Joint Filer
Joint Filer’s Social Security #
(abbreviation only)
_______
___________
_______________________________________
_______-______-_________
_______
___________
_______________________________________
_______-______-_________
_______
___________
_______________________________________
_______-______-_________
_______
___________
_______________________________________
_______-______-_________
*Filing Status – i.e.: (S) Single, (MFJ) Married Filing Joint Return, (MFS) Married Filing Separate Return, (HOF) Head of
Family, (W) Widowed
If you wish for your tax transcript to be sent, by mail, to anyone other than yourself, please provide their information below.
For information to be released to a third party, this form must be notarized.
NAME:
__________________________________________
ADDRESS:
__________________________________________
CITY, STATE, ZIP CODE:
__________________________________________
Please send my tax transcript to the person indicated above. I understand that by requesting my tax transcript to be sent to
a third party, I am waiving the confidentiality provisions of §27-3-73 and §27-7-83 of the Mississippi Code of 1972.
SIGNATURE:
_____________________________________
DATE: ______________
SWORN AND SUBSCRIBED BEFORE ME THIS THE ______ DAY OF _________________, 20____.
My Commission Expires:
__________________________
______________________
NOTARY PUBLIC
Seal
Payment of $10.00 must be submitted before this request will be processed. Payment must be in the form of cash, cashier’s
check, or money order. We do not accept personal checks for tax transcript requests. Please allow ten business days for
processing.
FOR MISSISSIPPI STATE TAX COMMISSION USE ONLY
The records of the Mississippi State Tax Commission indicate that a return was filed by the above referenced
taxpayer for the following years:
2008
Y / N
2007
Y / N
2006
Y / N
2005
Y / N
2004
Y / N
The Mississippi State Tax Commission certifies that, as of this date, this
information is true and correct based upon the information provided by the taxpayer.
In the event that the taxpayer supplied erroneous or incomplete information, this
transcript is subject to review/amendment by the Mississippi State Tax Commission.
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