Form 80-105 Mississippi Resident Individual Income Tax Return - 2016 Page 2

Download a blank fillable Form 80-105 Mississippi Resident Individual Income Tax Return - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 80-105 Mississippi Resident Individual Income Tax Return - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Mississippi

Page 2

Form 80-105-16-8-2-000 (Rev. 4/16)

Resident Individual Income Tax Return

2016

801051682000

SSN

INCOME

Column A (Taxpayer)

Column B (Spouse)

Wages, salaries, tips, etc. (complete Form 80-107)

37A

37B

Business income (loss) (attach Federal Schedule C or C-EZ)

38A

38B

Capital gain (loss) (attach Federal Schedule D, if applicable)

39A

39B

Rent, royalties, partnerships, S corporation trusts, etc.

(from Form 80-108, part IV)

40A

40B

Farm income (loss) (attach Federal Schedule F)

41A

41B

Interest income (from Form 80-108, part II, line 3)

42A

42B

Dividend income (from Form 80-108, part II, line 6)

43A

43B

Alimony received

44A

44B

Taxable pensions and annuities (complete Form 80-107)

45A

45B

Unemployment compensation (complete Form 80-107)

46A

46B

Other income (loss) (from Form 80-108, part V, line 10)

47A

47B

Total income (add lines 37 through 47)

48A

48B

ADJUSTMENTS

Column A (Taxpayer)

Column B (Spouse)

Payments to IRA

49A

49B

Payments to self-employed SEP, SIMPLE and qualified retirement plans

50A

50B

Interest penalty on early withdrawal of savings

51A

51B

Alimony paid (complete below)

52A

52B

Name

SSN

State

Name

SSN

State

Name

SSN

State

Moving expense (attach Federal Form 3903)

53A

53B

National Guard or Reserve pay (enter the lesser of amount or $15,000)

54A

54B

Mississippi Prepaid Affordable College Tuition (MPACT)

55A

55B

Mississippi Affordable College Savings (MACS)

56A

56B

Self-employed health insurance deduction

57A

57B

Health savings account deduction

58A

58B

Catastrophe savings account deduction

59A

59B

Total adjustments (add lines 49 through 59)

60A

60B

Mississippi adjusted gross income (line 48 minus line 60; enter

61A

61B

on page 1, line 13)

AMENDED RETURN - EXPLANATION OF CHANGES TO ORIGINAL RETURN (attach additional statement if needed)

This return may be discussed with the preparer

Yes

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

Date

Spouse Signature

Paid Preparer Email Address

Paid Preparer Phone Number

Date

Paid Preparer Signature

Paid Preparer Address

City