Mississippi Non-Resident and Part-Year Resident Return

Non-Resident and Part-Year Resident Return
80205238
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Mississippi

Form 80-205-23-8-1-000 (Rev. 11/23)

Non-Resident / Part-Year Resident
Individual Income Tax Return
2023

802052381000
Non-Resident

Part-Year, Tax Year Beginning

Taxpayer First Name

Initial Last Name

Spouse First Name

Initial Last Name

and Ending
SSN
Spouse SSN
1

Mailing Address (Number and Street, Including Rural Route)

2
3

City

State

Amended

County Code

Zip

4
5

Married - Combined or Joint Return ($12,000)
Married - Spouse Died in Tax Year ($12,000)
Married - Filing Separate Returns ($12,000)
Head of Family ($8,000)
Single ($6,000)

EXEMPTIONS
Dependents (in column B, enter "C" for child, "P" for parent or "R" for relative)
(B)
(C) Dependent SSN
6 (A) Name

7

Total number of dependents (from line 6 and Form 80-491)

PRORATION

8

9
10
11
12

Taxpayer Age 65 or Over
Taxpayer Blind

Spouse Age 65 or Over
Spouse Blind

Total dependents line 7 plus number of boxes checked line 8
Line 9 x $1,500
10
Enter filing status exemption
11
Total (line 10 plus line 11)
12

(COMPLETE PAGE 2 BEFORE PROCEEDING FURTHER)

13a Mississippi adjusted gross income

14a Standard or itemized deductions

.

00
b Adjusted gross income from all sources

.00

.

15a Exemptions (from line 12; if married
filing separate, use 1/2 amount)

.

00
b Mississippi deductions
(line 14a multiplied by line 13c)

b Mississippi exemption
(line 15a multiplied by line 13c)

.00

c Line 13a divided by line 13b

%

16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Mississippi adjusted gross income (from page 2, line 67 or line 68)
16A
Deductions (from line 14b; if itemized, attach Form 80-108)
17A
Exemptions (from line 15b)
18A
Mississippi taxable income (line 16 minus line 17 and line 18)
19A
Income tax due (from Schedule of Tax Computation, see instructions)
Other credits (from Form 80-401, line 1)
Net income tax due (line 20 minus line 21)
Consumer use tax (see instructions)
Catastrophe savings tax (see instructions)
Total Mississippi income tax due (line 22 plus line 23 and line 24)
Mississippi income tax withheld (complete Form 80-107)
Estimated tax payments, extension payments and/or amount paid on original return
Credit for tax paid on an electing Pass-Through Entity Tax Return (from Form 80-161, line 3D)
Refund received and/or amount carried forward from original return (amended return only)
Total payments (line 26 plus line 27 and line 28 minus line 29)

31
32
33
34
35

Overpayment (if line 30 is more than line 25, subtract line 25 from line 30; if zero, skip to line 36)
Interest and penalty (from Form 80-320, line 11 and/or line 12)
Adjusted overpayment (line 31 minus line 32)
Farmers or Fishermen
Overpayment to be applied to next year estimated tax account
(see instructions)
Overpayment refund (line 33 minus line 34)

Column B (Spouse)

.00
.00
.00
.00

REFUND

31
32
33
34
35

.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00

36
37
38

.00
.00
.00

16B
17B
18B
19B
20
21
22
23
24
25
26
27
28
29
30

Direct Deposit Request
(check box and go to page 3)

Balance due (if line 25 is more than line 30, subtract line 30 from line 25)
Interest and penalty (from Form 80-320, line 19)
Total due (line 36 plus line 37)

.00
.00

Column A (Taxpayer)

MISSISSIPPI INCOME TAX

36
37
38

.00
.00
.00

BALANCE DUE
AMOUNT YOU OWE

Installment Agreement Request
(see instructions for eligibility; attach Form 71-661)

PLEASE SIGN THIS TAX RETURN ON THE BOTTOM OF PAGE 3

Mississippi

Form 80-205-23-8-2-000 (Rev. 11/23)

802052382000

Non-Resident / Part-Year Resident
Individual Income Tax Return
2023

Page 2

SSN
Total Income From All Sources

INCOME
39
40
41

Wages, salaries, tips, etc. (complete Form 80-107)
Business income (loss) (attach Federal Schedule C or C-EZ)
Capital gain (loss) (attach Federal Schedule D, if applicable)

42

Rent, royalties, partnerships, S corporations, trusts, etc.
(from Form 80-108, part IV)

43
44
45
46
47
48
49
50

Farm income (loss) (attach Federal Schedule F)
Interest income (from Form 80-108, part II, line 3)
Dividend income (from Form 80-108, part II, line 6)
Alimony received
Taxable pensions and annuities (complete Form 80-107)
Unemployment compensation (complete Form 80-107)
Other income (loss) (from Form 80-108, part V, line 10)
Total income (add lines 39 through 49)

ADJUSTMENTS
51
52
53
54

39
40
41
42

.00
.00
.00
.00

39
40
41
42

.00
.00
.00
.00

43
44
45
46
47
48
49
50

.00
.00
.00
.00
.00
.00
.00
.00

43
44
45
46
47
48
49
50

.00
.00
.00
.00
.00
.00
.00
.00

Total Income From All Sources

Payments to IRA
Payments to self-employed SEP, SIMPLE and qualified retirement plans
Interest penalty on early withdrawal of savings
Alimony paid (complete below)
Name

Mississippi Income ONLY

SSN

55
56
57
58
59
60
61
62
63
64
65
66

Moving expense (attach Federal Form 3903)
National Guard or Reserve pay (enter the lesser of amount or $15,000)
Mississippi Prepaid Affordable College Tuition (MPACT)
Mississippi Affordable College Savings (MACS)
Self-employed health insurance deduction
Health savings account deduction
Catastrophe savings account deduction
Self-employment tax deduction
First-time home buyer saving account deduction
Agricultural disaster program compensation deduction
Mississippi Achieving a Better Life Experience (ABLE) Act deduction
Total adjustments (add lines 51 through 65)

67

Adjusted gross income (line 50 minus line 66; enter total AGI
on page 1, line 13b and Mississippi AGI line 13a)

68

Split Mississippi AGI on line 67 between taxpayer and spouse

.00
.00
.00
.00

51
52
53
54
State

Mississippi Income ONLY
51
52
53
54

.00
.00
.00
.00

Date of Divorce

55
56
57
58
59
60
61
62
63
64
65
66
67

.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00

55
56
57
58
59
60
61
62
63
64
65
66
67

.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00

T 68

.00

S 68

.00

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

Mississippi

Form 80-205-23-8-3-000 (Rev. 11/23)

Non-Resident / Part-Year Resident
Individual Income Tax Return
2023

802052383000

Page 3

SSN
DIRECT DEPOSIT INFORMATION
1

Overpayment refund (from page 1, line 35)

a

Routing Number 1

.00

1

Account Number 1

Checking

Savings

Direct Deposit 1 Amount

.00

1a
b

Routing Number 2

Account Number 2

Checking

Savings

Direct Deposit 2 Amount

.00

1b

SIGNATURE
This return may be discussed with the preparer

Yes

No

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

Spouse Signature

Date

Paid Preparer Phone Number

Paid Preparer Email Address

Paid Preparer Signature

Date

Paid Preparer Address

City

Mail REFUND returns to: Department of Revenue, P.O. Box 23058, Jackson, MS 39225-3058
Mail all other returns to: Department of Revenue, P.O. Box 23050, Jackson, MS 39225-3050
Duplex and Photocopies NOT Acceptable

State

Zip Code