Married - Filing Separate Returns ($12,000) Spouse SSN County Code Zip City Taxpayer First Name SSN Spouse First Name Initial Taxpayer Blind Taxpayer Age 65 or Over Spouse Age 65 or Over Spouse Blind 12 Total (line 10 plus line 11) 7 Total number of dependents (from line 6 and Form 80-491) 9 Total dependents line 7 plus number of boxes checked line 8 14 Standard or itemized deductions (if itemized, attach Form 80-108) 15 Exemptions (from line 12; if married filing separately use 1/2 amount) 16 Mississippi taxable income (line 13 minus line 14 and line 15) Mailing Address (Number and Street, Including Rural Route) State Last Name 4 1 5 2 Married - Combined or Joint Return ($12,000) Head of Family ($8,000) Single ($6,000) 3 Mississippi 2022 Married - Spouse Died in Tax Year ($12,000) 801052281000 Form 80-105-22-8-1-000 (Rev. 11/22) 8 Amended (C) Dependent SSN (A) Name 6 (B) MISSISSIPPI INCOME TAX 25 Mississippi income tax withheld (complete Form 80-107) 26 Estimated tax payments, extension payments and/or amount paid on original return 28 Total payments (line 25 plus line 26 minus line 27) 27 Refund received and/or amount carried forward from original return (amended return only) 29 Overpayment (if line 28 is more than line 24, subtract line 24 from line 28; if zero, skip to line 35) 31 Adjusted overpayment (line 29 minus line 30) 32 Overpayment to be applied to next year estimated tax account 33 Voluntary contribution (from Form 80-108, part III) 10 10 Line 9 x $1,500 11 Enter filing status exemption Dependents (in column B, enter "C" for child, "P" for parent or "R" for relative) 13 Mississippi adjusted gross income (from page 2, line 66) 35 Balance due (if line 24 is more than line 28, subtract line 28 from line 24) 30 Interest and penalty (from Form 80-320, line 11 and/or line 12) Initial PAYMENTS REFUND OR BALANCE DUE REFUND BALANCE DUE PLEASE SIGN THIS TAX RETURN ON THE BOTTOM OF PAGE 3 Installment Agreement Request (see instructions for eligibility; attach Form 71-661) .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 11 12 13A 14A 15A 16A 23 13B 14B 15B 16B 18 19 21 22 24 25 26 27 29 30 31 32 33 Farmers or Fishermen (see instructions) 36 Interest and penalty (from Form 80-320, line 19) .00 34 37 Total due (line 35 plus line 36) 35 .00 Column A (Taxpayer) Column B (Spouse) 17 Last Name 34 Overpayment refund (line 31 minus line 32 and line 33) .00 36 AMOUNT YOU OWE .00 28 37 .00 EXEMPTIONS Direct Deposit Request (check box and go to page 3) Resident Individual Income Tax Return 17 Income tax due (from Schedule of Tax Computation, see instructions) 18 Credit for tax paid to another state (from Form 80-160, line 13; attach other state return) 19 Credit for tax paid on an electing Pass-Through Entity Tax Return (from Form 80-161, line 3d) 20 Other credits (from Form 80-401, line 1) 21 Net income tax due (line 17 minus line 18, line 19 and line 20) 22 Consumer use tax (see instructions) 23 Catastrophe savings tax (see instructions) 24 Total Mississippi income tax due (line 21 plus line 22 and line 23) 20 .00 Reset Form Print Form

Mississippi Resident Individual Income Tax Return 2022 Page 2 801052282000 Form 80-105-22-8-2-000 (Rev. 11/22) SSN Column A (Taxpayer) Column B (Spouse) 49 Total income (add lines 38 through 48) 47 Unemployment compensation (complete Form 80-107) 45 Alimony received 46 Taxable pensions and annuities (complete Form 80-107) 48 Other income (loss) (from Form 80-108, part V, line 10) 43 Interest income (from Form 80-108, part II, line 3) 44 Dividend income (from Form 80-108, part II, line 6) 40 Capital gain (loss) (attach Federal Schedule D, if applicable) 41 Rent, royalties, partnerships, S corporations, trusts, etc. (from Form 80-108, part IV) 39 Business income (loss) (attach Federal Schedule C or C-EZ) 42 Farm income (loss) (attach Federal Schedule F) 51 Payments to self-employed SEP, SIMPLE and qualified retirement plans 52 Interest penalty on early withdrawal of savings 53 Alimony paid (complete below) 50 Payments to IRA 54 Moving expense (attach Federal Form 3903) 55 National Guard or Reserve pay (enter the lesser of amount or $15,000) 56 Mississippi Prepaid Affordable College Tuition (MPACT) 59 Health savings account deduction 58 Self-employed health insurance deduction 65 Total adjustments (add lines 50 through 64) 57 Mississippi Affordable College Savings (MACS) 38 Wages, salaries, tips, etc. (complete Form 80-107) 66 Mississippi adjusted gross income (line 49 minus line 65; enter on page 1, line 13) INCOME Name State SSN Column A (Taxpayer) Column B (Spouse) ADJUSTMENTS .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 60A 38A 39A 40A 41A 42A 43A 44A 45A 60B 38B 39B 40B 41B 42B 43B 44B 45B 48A 49A 48B 49B 52A 53A 54A 55A 56A 57A 52B 53B 54B 55B 56B 57B AMENDED RETURN - EXPLANATION OF CHANGES TO ORIGINAL RETURN (attach additional statement if needed) .00 .00 65A 65B .00 .00 46A 46B .00 .00 50A 50B .00 .00 58A 58B .00 .00 47A 47B .00 .00 51A 51B .00 .00 59A 59B 60 Catastrophe savings account deduction .00 61B .00 61A .00 66B .00 66A 61 Self-employment tax deduction .00 62B .00 62A 62 First-time home buyer savings account deduction 63 Agricultural disaster program compensation deduction .00 .00 64A 64B Date of Divorce .00 63B .00 63A 64 Mississippi Achieving a Better Life Experience (ABLE) Act deduction

Mississippi Resident Individual Income Tax Return 2022 Page 3 801052283000 Form 80-105-22-8-3-000 (Rev. 11/22) SSN Paid Preparer Signature Date Paid Preparer Address Date Taxpayer Signature Taxpayer Phone Number Paid Preparer PTIN Paid Preparer Phone Number City State Zip Code Spouse Signature Date Paid Preparer Email Address 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. This return may be discussed with the preparer Yes No DIRECT DEPOSIT INFORMATION 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 SIGNATURE Overpayment refund (from page 1, line 34) 1 .00 1a .00 1b .00 Routing Number 1 a Routing Number 2 b Account Number 1 Account Number 2 Direct Deposit 1 Amount Direct Deposit 2 Amount Checking Checking Savings Savings 1