Mississippi Installment Agreement

Installment Agreement
71661238
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Form 71-661-23-8-1-000 (Rev. 11/23)

Mississippi

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Installment Agreement
MUST BE ATTACHED TO FRONT OF RETURN
DO NOT file this form if you are currently making payments on an installment agreement. If you are in bankruptcy, see instructions.
Taxpayer First Name

Initial Last Name

SSN

Spouse First Name

Initial Last Name

Spouse SSN

Mailing Address (Number and Street, Including Rural Route)

City

State

Phone Number

Extension

Zip

County Code

If this address is new since you filed
your last tax return, check here:

Best Time to Call

Banking Information

Employer Information

Name of your bank or other financial institution

Your employer's name

Address

Address

City, State, Zip Code

City, State, Zip Code

Payment Information
1 Enter the tax year for which you are making this request

1

2 Enter the total amount you owe (as shown on your return)

2

.00

3 Enter the amount of any payment you are making with your tax return (see instructions)

3

.00

4 Enter the amount due each month (interest will continue until you pay in full)

4

.00

Instructions
An installment agreement is available to taxpayers that have a tax liability of at least $75. In order to qualify for the installment agreement, the return
must be filed on or before the due date, or any extensions allowed, and this request form must be submitted with the return. You (and your spouse if a
joint return) must have filed all required income tax returns and paid all taxes due for the past five years. You also can not have previously entered
into an installment agreement during the past five years.
There are two (2) types of installment agreements for taxpayers that have a tax liability:
(1)

Tax liability of $75 but no more than $3,000 - The installment agreement allows you to pay the amount due in twelve equal installments.

(2)

Tax liability exceeding $3,000 and an installment agreement with the Internal Revenue Service (IRS) for the same tax year. The installment
agreement allows you to pay the amount due within sixty months. You must attach a copy of the approved installment agreement
notification from the IRS.

• The agreement may be terminated if any installment payment is not made timely. It may also be terminated if you do not pay any other tax liability
when the liability is due.
• Interest of 1/2 % per month continues to accrue during the installment agreement period. You will need to contact our office for the remaining balance
on the account prior to the last payment to ensure the interest is paid correctly.
• If you have a pending bankruptcy case, you may be barred by federal law from participation in an installment agreement. Please contact our office for
more details. Additionally, if you file bankruptcy during the installment period, you must notify our Bankruptcy Section immediately at 601-923-7393.
Due to the automatic stay provisions of the U.S. Bankruptcy Code, the installment agreement may be void at the time you file your bankruptcy case.

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