80-110 Form Mississippi Ez Individual Income Tax Return

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Form 80-110-16-8-1-000 (Rev. 4/16)
Mississippi
Print Form
EZ Individual Income Tax Return
2016
Amended
801101681000
This form is for a SINGLE person with no dependents, having wages and interest income only
Taxpayer First Name
Initial
Last Name
Mailing Address (Number and Street, Including Rural Route)
SSN
City
State
Zip
County Code
INCOME TAX
.
1
Wages, salaries, tips, etc. (complete Form 80-107)
1
00
.
2
Taxable interest income
2
00
.
3
Mississippi adjusted gross income (line 1 plus line 2)
3
00
4
Total of exemption and standard deduction
4
$ 8,300.00
.
5
Taxable income (line 3 minus line 4); if less than zero, enter zero
5
00
.
6
Total income tax due (see computation table on back)
6
00
.
7
Consumer use tax
7
00
.
8
Total tax due (line 6 plus line 7)
8
00
PAYMENTS
.
9
Mississippi income tax withheld (complete Form 80-107)
9
00
.
10
Payments and/or amount paid on original return
10
00
.
11
Refund received from original return (amended return only)
11
00
.
12
Total payments (line 9 plus line 10 minus line 11)
12
00
REFUND OR BALANCE DUE
(If no overpayment is due on line 13, skip to line 18)
.
13
Overpayment (if line 12 is more than line 8, subtract line 8 from line 12)
13
00
.
14
Interest on underestimated tax (from Form 80-320, line 11)
14
00
.
15
Adjusted Overpayment (line 13 minus line 14)
15
00
16
Voluntary Contributions (see instructions)
.
.
Military Family Relief Fund
Bicentennial Celebration Fund
00
00
.
.
Burn Care Fund
Wildlife Fisheries and Parks Foundation
00
00
.
.
Wildlife Heritage Fund
Commission for Volunteer Service Fund
00
00
.
.
Educational Trust Fund
Enter total contributions
16
00
00
.
17
Refund (line 15 minus line 16)
17
00
.
18
Balance due (if line 8 is more than line 12, subtract line 12 from line 8)
18
00
.
19
Interest, penalty and interest on underestimated tax (from Form 80-320, line 18)
19
00
.
20
Total due (line 18 plus line 19)
20
00
Yes
No
Installment Agreement Request (see instructions for eligibility)
This return may be discussed with the preparer
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
Paid Preparer Address
City
State
Zip Code
Date
Paid Preparer Signature
Paid Preparer Email Address
Paid Preparer Phone Number
Mail returns requesting a REFUND 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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