Mississippi Affidavit for Withholding Income Tax on Sale of Real Estate by Non-Resident

Affidavit for Withholding Income Tax on Sale of Real Estate by Non-Resident
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Form 89-386-21-8-1-000 (Rev.08/21)

Mississippi
Affidavit for Withholding Income Tax
on Sale of Real Estate by
Non-Resident

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, duly swears under penalty of perjury the following facts:
Seller's Name
1. Seller's Name and Address

Address
City

State

Zip

2. Description, location and tax map parcel number of property sold

3. Buyer's Name and Address
Buyer's Name
Address

City

State

Zip

Closing date

4. The total sales price is
5. The gain to be reported on the seller's MS Income Tax Return
(From Page 2, Schedule A, Line 5)
6. Income tax at 5% of the gain (Line 5 multiply by 5%)
7. The net proceeds payable to the seller (From Page 2, Schedule B, Line 5)
8. Income tax amount required to be withheld . (Enter the smaller of line 6 or
line 7)
9. The seller will file all state Income Tax Returns due

Witness my signature, this the

Social Security Number

Social Security Number or ID Number of Spouse
Seller's Signature

Signature of Spouse

Day of

, 20

State of

County of
This day personally appeared before me, the undersigned authority of law in
and for said county and state, the above signed seller who acknowledges that he
signed and delivered this affidavit on the day and year and for the purposes
mentioned therein.
Given under my hand and seal, this the
Day of

Mail To: MS Department of Revenue
P.O. Box 23050
Jackson, MS 39225-3050

, 20

My Commission Expires

Notary Public

Form 89-386-21-8-2-000 (Rev.08/21)

Mississippi
Affidavit for Withholding Income Tax
on Sale of Real Estate by
Non-Resident

Page 2

Only mortgages and liens on the property being sold may be deducted from the sales price. Mortgages, liens or
advances on credit lines in contemplation of the sale cannot be deducted unless, the buyer can presume that any
mortgage, lien or credit lines made more than one year before the closing are not in contemplation of the sale and may
be deducted. If the mortgage, lien or credit line advance is made less than one year prior to the closing, the buyer cannot
deduct the mortgage, lien or credit line advance unless the buyer obtains an affidavit from the seller, which states that the
loan or advance was not made in contemplation of the sale and meets the requirements and includes all of the
information contained in this affidavit.

Schedule A - Computation of Gain
1. Total sales price
2. Less selling expenses - Attorney fees
Real estate commission
Termite, heating & air letter fees
Other - list

3. Net sales price (Line 1 minus Line 2)
4. Less tax basis
5. Gain for tax purposes (Line 3 minus Line 4, enter here and on Page 1, Line 5)

Schedule B - Computation of Net Proceeds
1. Total sales price
2. Less selling expenses - Attorney fees
Real estate commission
Termite, heating & air letter fees
Other - List

3. Net sales price (Line 1 minus Line 2)
4. Less mortgages, liens or advances on credit lines not made in contemplation of the sale (see above)
5. Net proceeds payable to the seller (Line 3 minus Line 4, enter here and on Page 1, Line 7)