Form 83-180-14-8-1-000 - Mississippi Application For Automatic Six Month Extension - 2014

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Form 83-180-14-8-1-000 (Rev. 05/14)
Mississippi
Application for Automatic Six Month Extension
831801481000
2014
Tax Year Beginning
Tax Year Ending
m m d d y y y y
m m d d y y y y
FEIN
Mississippi Secretary of State ID
Legal Name and DBA
CHECK ALL THAT APPLY
Address
C Corporation
Initial Return
S Corporation
Final Return
City
State
Zip+4
Partnership / LLC / LLP
Composite Return
1
Extension payment amount
.
Enter the total amount of payment remitted by reporting entity for all members of affiliated group listed below.
00
NAME
FEIN
SSN
IDENTIFICATION NUMBER
AMOUNT OF PAYMENT
2
2
.
00
3
3
.
00
4
4
.
00
5
5
.
00
6
6
.
00
7
7
.
00
8
8
.
00
9
9
.
00
10
10
.
00
11
11
.
00
12
12
.
00
13
13
.
00
14
.
14
00
15
15 Total of amounts entered on line 2 through line 14
.
00
16
.
16 Total amounts from all supplemental pages (Form(s) 83-180)
00
17
.
17 Total extension payment (add line 15 and line 16; total should equal payment amount on line 1)
00
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.
Officer / Agent Signature
Title
Date
Mail To: Department of Revenue P.O. Box 23050 Jackson, MS 39225-3050

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