Form 80-110 EZ Resident

Amended Income Tax Rates Taxable Income $0 $5 000 $8 300 00 (Add first three lines in Income Tax column together ) (Add first three lines in Taxable Income column together ) 1 Wages Salaries Tips etc (Must Complete Form 80 107) 10 Amount Paid with Original Return (Amended Return Only) 11 Total Payments (Line 9 plus Line 10) 12 Refund Received from Original Return (Amended Return Only) 13 Overpayment (If Line 11 is larger than Line 8 plus Line 12) 14 Enter Total Contributions 15 Refund (Line 13 minus Line 14) 16 Balance Due (If Line 8 plus Line 12 is larger than Line 11) 17 Interest and Penalty (Including Interest on Underpayment of Estimated Tax Form 80 320) 18 Total Due (Line 16 plus Line 17) Must Attach Check or Money Order 2 Taxable Interest Income 3 Mississippi Adjusted Gross Income (Line 1 plus Line 2) 4 Total of Exemption and Standard Deduction 5 Taxable Income (Line 3 minus Line 4) If Less Than 0 Enter 0 6 Total Income Tax Due (See Table on back) 7 Consumer Use Tax 8 Total Tax Due (Line 6 plus Line 7) 9 Mississippi Income Tax Withheld (From Form 80 107) Add Lines 6 and 7 Enter the total Add Lines 9 and 10 Enter the total Bicentennial Celebration Fund Burn Care Fund Code2Of5InterleavedBarCode4 801101281000 Commission for Volunteer Service Fund Do not pay any use tax you may owe on your income tax return if you currently have an active Use Tax Account Duplex and Photocopies NOT Acceptable Educational Trust Fund Enter amount of Income Tax Due Use the Taxable Income amount from Line 5 to compute your Income Tax Enter amount paid with original return This is for amended returns only Enter any penalty or interest due If payment is made past April 15 add 1% per month interest and 1/2% per Enter Balance Due if Line 8 plus Line 12 is larger than Line 11 Enter Refund amount by subtracting Line 12 from Line 11 Enter the amount of any refund received with original return This is for amended returns only Enter the amount of Mississippi withholding from the Individual W 2 Datasheet Form 80 107 If you have Enter the amount of your Overpayment if Line 11 is larger than Line 8 plus Line 12 Enter the total of your wages salaries tips etc from Individual W 2 Datasheet Form 80 107 Enter Total Due by adding Lines 13 and 14 Enter total of Line 1 plus Line 2 Enter your amount of Consumer Use Tax If during 2012 you made out of state purchases of goods or services Enter your taxable interest income EZ Individual First Name Form 80 110 12 8 1 000 (Rev 7/12) Form 80 110 12 8 2 000 (Rev 7/12) 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 you have an overpayment on Line 10 enter the amount of the overpayment if any you wish to contribute as a Income Tax Return Installment Agreement Request (See Instructions for eligibility) Instructions for EZ Individual Line 1 Line 10 Line 11 Line 12 Line 13 Line 14 Line 15 Line 16 Line 17 Line 18 Line 2 Line 3 Line 5 Line 6 Line 7 Line 8 Line 9 Line by line instructions 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) Middle Initial Military Family Relief Fund Mississippi month penalty The maximum penalty is 25% Next $5 000 Paid Preparer Address Paid Preparer Email Address Paid Preparer Phone Number Paid Preparer PTIN Paid Preparer Signature Payable to: Department of Revenue Remaining Balance Residence County Code See Instructions Form 80 100 ROUND TO THE NEAREST DOLLAR See instructions on back of form Spouse Signature State Subtract $8 300 from the amount on Line 3 Enter the result Tax Computation Taxpayer Last Name Taxpayer Phone Number Taxpayer Signature that you used stored or consumed in Mississippi and did not pay sales taxes to any state you are required to pay Mississippi Consumer Use Tax at a rate of 7% of the purchase price including any charges for shipping or handling An example of such purchases includes books clothing computers electronics furniture household items and downloads of digital products such as music movies e books and software This form is for a SINGLE person with no dependents having wages & interest income only This Return may be discussed with the preparer Total Income Tax Due Total Taxable Income Use Form 80 110 if you are single with no dependents and have wages and interest income only If you are filing an amended return please check the box Voluntary Contribution Check offs Voluntary Contribution(s) Wildlife Fisheries and Parks Foundation Wildlife Heritage Fund withholding from another state you cannot use the EZ Individual Income Tax Return Form 80 110 Use the Resident Individual Income Tax Return Form 80 105 YOU MUST ENTER SSN Zip Code