Form 80-105 Resident Return

Amended Residence County Code See Instructions YOU MUST ENTER SSN (A) Name (C) Dependent SSN 10 Total of Line 8 plus Line 9 11 Line 10 x $1 500 12 Enter Amount from Lines 1 through 5 13 Total (Line 11 plus 12) 14 If Filing MFS Returns Enter 1/2 of Line 13 15 Wages Salaries Tips etc (Complete Form 80 107) 16 Other Income (Amount from Line 49 Page 2 of this Form) 17 Adjustments to Gross Income (Amount from Line 60 Page 2 of this form) 18 Mississippi Adjusted Gross Income (Line 15 plus Line 16 minus Line 17) 19 Standard or Itemized Deductions (For Itemized Deductions Must Attach Form 80 108) 20 Amount of Exemption Line 13 (Line 14 if Married Filing Separately) 21 Mississippi Taxable Income 22 Total Income Tax Due (From Schedule of Tax Computation Form 80 100) 23 Credit for Tax Paid to Another State 24 Other Credits (From Form 80 401 Line 1) 25 Net Income Tax Due (Line 22 minus Line 23 and 24) 26 Consumer Use Tax (See Instructions Form 80 100) 27 Total Tax Due (Line 25 plus Line 26) 28 Mississippi Income Tax Withheld (Must Complete Form 80 107) 29 Estimated Tax Payments and/or Amount Paid on Original Return 30 Total Payments (Line 28 plus Line 29) 31 Refund Received And/Or Amount Carried Forward from Original Return (Amended Return Only) 32 Overpayment (If Line 30 is larger than Line 27 plus Line 31) 33 Overpayment to be Applied to Next Year Estimated Tax Account 34 Voluntary Contribution (From Form 80 108 Part 3) 35 Refund (Line 32 minus Line 33 and Line 34) 36 Balance Due (If Line 27 plus 31 is larger than Line 30) 37 Interest and Penalty (Including Interest on Underpayment of Estimated Tax Form 80 320) 38 Total Due (Line 36 plus Line 37) 39 Business Income (Loss) (Must Attach Federal Schedule C or C EZ) 40 Capital Gain (Loss) (Must Attach Federal Schedule D) 41 Rent Royalties Partnerships S Corp Trusts etc (From Form 80 108 Part 4) 42 Farm Income (Loss) (Must Attach Federal Schedule F) 43 Interest Income (From Form 80 108 Part 2 Line 3) 44 Dividend Income (From Form 80 108 Part 2 Line 6) 45 Alimony Received 46 Taxable Pensions and Annuities (Complete Form 80 107) 47 Unemployment Compensation (Complete Form 80 107) 48 Other Income(Loss) (From Form 80 108 Part 5) 49 Total Other Income (Add Lines 39 through 48 carry amounts to Page 1 Line 16) 50 Payments to IRA 51 Payments to Self Employed SEP SIMPLE & Qualified Retirement Plans 52 Interest Penalty on Early Withdrawal of Savings 53 Alimony Paid (Must Complete Below) 54 Moving Expense (Must Attach Federal Form 3903) 55 National Guard or Reserve Pay (Enter the Lesser of the Guard/ Reserve Pay or the $15 000 Statutory Exclusion Per Taxpayer) 56 MS Prepaid Affordable College Tuition (MPACT) 57 MS Affordable College Savings (MACS) 58 Self Employed Health Insurance Deduction 59 Health Savings Account Deduction 60 Total Adjustments (Add Lines 50 through 59 carry amounts to Page 1 Line 17) 8 Number of Boxes Marked "X" on Line 7 9 Number of Dependents Listed on Line 6 (List additional dependents on Form 80 491) Code2Of5InterleavedBarCode4 801051281000 Code2Of5InterleavedBarCode4 801051282000 Column A (Taxpayer) Column B (Spouse) Dependents (In column (B) Must enter C for child P for parent or R for relative) Duplex and Photocopies NOT Acceptable First Name Form 80 105 12 8 1 000 (Rev 07/12) Form 80 105 12 8 2 000 (Rev 07/12) Head of Family (Enter $8 000 on Line 12 Provide Name SSN and Relationship of the Dependent Living in the Home with You on Line 6 ) 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 If Filing a Combined Return Use Column A for Taxpayer and Column B for Spouse Otherwise Use Column A ONLY See instructions in booklet Installment Agreement Request (See Instructions for eligibility) Mail 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 Mailing Address (Number & Street Including Rural Route) Mark "X" Mark an "X" in only one box Married Combined or Joint Return (Enter $12 000 on Line 12 ) Married Filing Separate Returns (Enter $12 000 on Line 12 Enter Spouse Name and SSN in boxes provided above Cannot change from Joint to Separate after due date ) Married Spouse Died in Tax Year Enter surviving spouse first as taxpayer (Enter $12 000 on Line 12 Enter Spouse Name and SSN in boxes provided above ) Middle Initial Mississippi Name: Page 1 Page 2 Paid Preparer Address Paid Preparer Email Address Paid Preparer Phone Number Paid Preparer PTIN Paid Preparer Signature Resident Individual Income Tax Return Round to Nearest Dollar Single (Enter $6 000 on Line 12 ) Spouse Spouse Age 65 or Over Spouse Blind Spouse First Name Spouse Last Name Spouse Signature State State Taxpayer Age 65 or Over Taxpayer Blind Taxpayer Last Name Taxpayer Phone Number Taxpayer Signature This Return may be discussed with the preparer Zip Code