Duplex and Photocopies NOT acceptable 2022 Form 80-108-22-8-1-000 (Rev. 10/22) In the event you filed using the standard deduction on your federal return and wish to itemize for Mississippi purposes, use Federal Form 1040 Schedule A as a worksheet and transfer the information from the specific lines indicated to this Schedule A. b Less Mississippi gambling losses 2 a Medical and dental expenses b Multiply line 1 by 7.5% (.075) 3 a Total taxes paid 4 Total interest paid 5 Charitable contributions 6 Total casualty or theft loss (attach Federal Form 4684) 7 a Other miscellaneous deductions b Less state income taxes (or other taxes in lieu of) c Total other miscellaneous deductions (line 7a minus line 7b) c Total taxes paid deduction (line 3a minus line 3b) c Medical and dental expense deduction (line 2a minus line 2b) 1 Interest income from all sources 2 Amount of Mississippi nontaxable interest in line 1 3 Total Mississippi interest (line 1 minus line 2, enter here and on Form 80-105, line 43 or Form 80-205, line 44) 5 Amount of Mississippi nontaxable distributions reported in line 4 6 Total Mississippi dividends (line 4 minus line 5, enter here and on Form 80-105, line 44 or Form 80-205, line 45) 4 Total dividends from all sources Mississippi Adjustments And Contributions SSN 801082281000 PART III: VOLUNTARY CONTRIBUTION CHECK-OFFS (RESIDENTS ONLY) You may elect to voluntarily contribute all or part (at least $1) of your income tax refund to one or more of the funds listed below. Refer to the instruction booklet 80-100 (may be downloaded from our website at www.dor.ms.gov) for an explanation of the purpose of each of these funds and how the refund donations will be used. Military Family Relief Fund Wildlife Heritage Fund Educational Trust Fund Commission for Volunteer Service Fund Burn Care Fund Wildlife Fisheries and Parks Foundation Enter total of check-offs here and on Form 80-105, page 1, line 33 2a Taxpayer Name 2b 3a 3b 7a 7b 1 2 3 4 5 6 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 1 Federal adjusted gross income from Federal Form 1040, line 11 .00 1 8 .00 2c 3c 4 5 6 .00 .00 .00 .00 .00 7c .00 PART I: SCHEDULE A - ITEMIZED DEDUCTIONS (ATTACH FEDERAL FORM 1040 SCHEDULE A) PART II: SCHEDULE B - INTEREST AND DIVIDEND INCOME (FROM FEDERAL FORM 1040, SCHEDULE B) Page 1 8 Mississippi itemized deductions (add lines 2c, 3c, 4, 5, 6, 7c); enter here and on Resident Form 80-105, page 1, line 14 or Non-Resident Form 80-205, page 1, line 14a Reset Form Print Form

COLUMN A COLUMN B COLUMN C (ATTACH MISSISSIPPI K-1S AS APPLICABLE) Form 80-108-22-8-2-000 (Rev. 10/22) B INCOME (LOSS) FROM PARTNERSHIPS, S CORPORATIONS, ESTATES AND TRUSTS INCOME (LOSS) MISSISSIPPI K-1S NAME OF ENTITY 3 Rental real estate and royalty income (loss) for Mississippi purposes (line 1 plus line 2) 1 Total rental real estate and royalty income (loss) (from Federal Schedule E, Part 1 and Part 5; attach Federal Schedule E) 2 Add: depletion claimed in excess of cost basis Page 2 A INCOME (LOSS) FROM RENTAL REAL ESTATE AND ROYALTIES FEIN (MUST INCLUDE FEIN) C Total of Section A and Section B income (loss)(line A3 plus line B1); enter here and on Form 80-105, line 41 or Form 80-205, line 42 SSN 801082282000 1 Total income (loss) from partnerships, s corporations, estates and trusts (Column C) A1 A2 A3 PART V: SCHEDULE N - OTHER INCOME (LOSS) AND SUPPLEMENTAL INCOME 6 1 4 5 Total Schedule N Other Income (Loss); enter here and on Form 80-105, page 2, line 48 or Form 80-205, page 2, line 49 Net operating loss (enter from Form 80-155, line 2) 1 4 5 6 .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 7 7 .00 8 8 .00 10 10 9 9 .00 2022 Mississippi Adjustments And Contributions List other types of income (loss) PART IV: INCOME (LOSS) FROM RENTS, ROYALTIES, PARTNERSHIPS, S CORPORATIONS, TRUSTS AND ESTATES 2 2 .00 First-time home buyer unqualified expenses 3 Catastrophe savings taxable distribution 3 .00 B1 C