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Provider Version of Form 72-200-01-3
Special City Sales Tax Return
This form is not to be used by your taxpayer until the July 2001 tax period that is due by August 20, 2001. The use of the
attached form prior to August 2001, will result in such form being sent back to the taxpayer without processing. A penalty may
be assessed to you or the taxpayer.
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MS Mississippi
Special City Sales Tax Return Form 72-200-01-3-1-000 (Rev. 7/01) ST
IMPORTANT: This form must be filed even if no tax is due.
722000131000 Photocopies or hand completed forms are NOT acceptable. DIRECT 030
AD Address Change ACCOUNT NUMBER TAX PERIOD Tax Calculation
Make changes below
AC TP 1.Taxable Income
FN Final Return 2.Rate of Tax 1/4 of 1%
Close account
FILING STATUS DUE ON OR BEFORE 3.Amount of Tax Due
AM Amended Return FS DD 4.Less: Discount(2% of line 3)
Replace original return
5.Net Tax Due
AT Additional Tax 6.Late Filing Penalty (See Instructions)
Supplement original return
7.Credit Adjustments (See Instructions)
8.Additional Assessments (See Instructions)
9.Total Due
I declare, under the penalties of perjury, that this return (including any accompanying
schedules) has been examined by me and to the best of my knowledge and belief is a
true, correct and complete return.
Signature of Taxpayer or Agent Phone Date
Cut on Dotted Line Before Filing
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MS Mississippi
Special City Sales Tax Return Form 72-200-01-3-1-000 (Rev. 7/01) ST
722000131000 IMPORTANT: This form must be filed even if no tax is due. DIRECT 030
Photocopies or hand completed forms are NOT acceptable.
6/8 Address Change ACCOUNT NUMBER TAX PERIOD Tax Calculation
Make changes below
20/9 to 33/9 34/9 to 47/9 1.Taxable Income 70/9 to 79/9
6/10 Final Return 2.Rate of Tax 75/10 to 79/10
Close account
FILING STATUS DUE ON OR BEFORE 3.Amount of Tax Due 70/11 to 79/11
6/12 Amended Return 20/12 to 33/12 34/12 to 47/12 4.Less: Discount(2% of line 3) 70/12 to 79/12
Replace original return
5.Net Tax Due 70/13 to 79/13
6/14 Additional Tax 6.Late Filing Penalty (See Instructions) 70/14 to 79/14
Supplement original return
7.Credit Adjustments (See Instructions) 70/15 to 79/15
8.Additional Assessments (See Instructions) 70/16 to 79/16
9.Total Due 70/17 to 79/17
I declare, under the penalties of perjury, that this return (including any accompanying
schedules) has been examined by me and to the best of my knowledge and belief is a
true, correct and complete return.
Signature of Taxpayer or Agent Phone Date
Cut on Dotted Line Before Filing
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MS Mississippi
Special City Sales Tax Return Form 72-200-01-3-1-000 (Rev. 7/01) ST
IMPORTANT: This form must be filed even if no tax is due.
722000131000 Photocopies or hand completed forms are NOT acceptable. DIRECT 030
Address Change ACCOUNT NUMBER TAX PERIOD Tax Calculation
Y Make changes below
025-12345-7 07 01 1.Taxable Income 80000
Final Return
N Close account 2.Rate of Tax 1/4 of 1%
FILING STATUS DUE ON OR BEFORE 3.Amount of Tax Due 5600
Amended Return
N Replace original return Monthly 08/20/01 4.Less: Discount(2% of line 3) 50
5.Net Tax Due 5550
Additional Tax
N Supplement original return John's Road House 6.Late Filing Penalty (See Instructions) 0
123 Road House Rd. 7.Credit Adjustments (See Instructions) 0
Raymond, Ms 39154 8.Additional Assessments (See Instructions) 0
9.Total Due 5550
I declare, under the penalties of perjury, that this return (including any accompanying
schedules) has been examined by me and to the best of my knowledge and belief is a
true, correct and complete return.
Signature of Taxpayer or Agent Phone Date
Cut on Dotted Line Before Filing
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Key to Data Fields for the Mississippi Special City Sales Tax Return 72-200-01-3
Key to the data fields for the sales tax coupon form version for 2001/2002, Form Number 72-200-01-3. All grid locations are presented as: x/y
the beginning location to x/y as the ending location on the 10/6 grid.
Page 1
The top left corner of the barcode is located at position 6/4 to 20/4.
The top right registration mark is located at the top right corner at grid 80/4.
The lower left registation mark is located at the lower left corner at grid 6/25.
"MS" to the left of the header must begin at grid 27/4 and end at grid 28/4 and is in a Courier 12pt.
The "ST" in the right corner begins at grid space 70/4 and ends at grid 73/4 and is Arial 18 pt.
If a draft version of this form is released in your software, the print function must be disabled. If a draft version is filed, it will be returned to
the taxpayer and a penalty may apply to you or your customer.
Provider forms are only accepted after approval. It is not acceptable for a taxpayer to print out a blank copy of the form and hand complete it.
A hand completed version of a provider form will be sent back to the taxpayer and a penalty may apply to you or your customer. All forms
must be original laser printed forms. Photocopies are NOT acceptable.
The following is the labeling and the description of the items to be included in this form. The beginning and ending data positions are included
in one of the templates for this form. The field length is included in this key for each data position. Grid positioning given is from the first grid
space and through the last grid space included in a data field. (Example 27/10 to 36/10 is 10 grid spaces). Use this information to position the
data on the returns. Do not use a grid overlay to determine the positions from a printed paper form. The field length specified assumes using a
Courier 12pt. font or OCR-A 12pt. font, which are the required fonts. All data fields should be right justified. All fields must be filled. If the
field is blank a "0" should be used for numeric field, an "N" should be used for an alpha field.
The money fields should not contain any commas, cents, decimals or other formatting information except for the negative signs (-) as a leading
indicator for any negative amount.
Front (Page 1) of the form:
Field Name Description
AC Account Number - The account number field should be 11 digits long and contain leading zeros. The last digit in the
account number is a check digit. This will be part of the account number funished to the taxpayer. Data position is
20/9 to 33/9.
TP Tax Period - Taxpayer may file monthly, quarterly, or annual. Example - July of 2001 should appear as 07 01. The
third quarter of 2001 sales tax year should appear as 07 09 01. Allowable periods are: Quarterly - July thru Sept.,
2001, Oct. thru Dec., 2001, Jan. thru Mar., 2002 and Apr. thru June, 2002. Annual Jan. thru Dec., 2001 and should
appear as 01 12 01. This field is 5 to 8 characters long. Data position is 34/9 to 47/9.
AD Address Change - Y or N in the form. If this is Y, then the new address should be entered in the address field in the
body of the form. An N if there is no change. This field is 1 character long. Data position is 6/8.
FN Final Return - Y or N in the form. This should be Y if this is the last return and the account should be closed. An N if
there is no change. This field is 1 character long. Data position is 6/10.
AM Amended Return - Y or N in the body of the form. If Y, this return should replace the original return, not supplement
it. An N if there is no change. This field is 1 character long. Data position is 6/12.
AT Additional Tax - Y or N in the form. If Y, this is additional tax that should supplement the original return. An N if
there is no change.This field is 1 character long. Data position is 6/14.
FS Filing Status - This should be monthly, quarterly, or annual. This field is 14 characters long. Data position is 20/12
to 33/12.
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| DD Due Date - The due date should always be the 20th of the month following the period for which the tax is due. Example - January 2002 will be due on February 20, 2002. This field is 14 characters long. Data Position is 34/12 to 47/12. 1 This is a money field and is 10 characters long. Data position is 70/9 to 79/9. 2 Rate of tax- This field should always have 1/4 of 1% in it. This can be a permanent part of the form. Do not put variable in this field. This field is five characters long. Data position is 75/10 to 79/10. 3 This is a money field and is 10 characters long. Data position is 70/11 to 79/11. 4 This is a money field and is 10 characters long. Data position is 70/12 to 79/12. 5 This is a money field and is 10 characters long. Data position is 70/13 to 79/13. 6 This is a money field and is 10 characters long. Data position is 70/14 to 79/14. 7 This is a money field and is 10 characters long. Data position is 70/15 to 79/15. 8 This is a money field and is 10 characters long. Data position is 70/16 to 79/16. 9 This is a money field and is 10 characters long. Data position is 70/17 to 79/17. |