Form 83-180-12-8-1-000 - Application For Automatic Six-Month Extension - 2012 Page 2

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Mississippi
Form 83-180-12-8-2-000 (Rev. 05/12
MS
Application for Automatic Six-Month Extension
831801282000
Page 2
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FEIN
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Amount of Payment
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Subtotal
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(Add Lines and Enter Total Amount on Form 83-180, Line 17.)
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