Form 72-010-22-3-1-000 (Rev. 04/22)
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04                                                                                                                                                                                                                                     04
05                                                                                                 Mississippi                                                                                                                         05
06       720102231000                                                   SALES & SPECIAL Tax Return                                                                                                                                     06
07                                                                                                                                                                                                                                     07
08                                                                                                                                                                                                                                     08
09 1a. TAX CODE - GENERAL SALES                                                              74                Name:       X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                                                            09
10                                                                                                                                                                                                                                     10
11 2a. Gross Income or Sales                                         9999999                                   Account ID:                   99999999                                                                                  11
12                                                                                                                                                                                                                                     12
       (From Schedule on Back)
13 3a. Deductions                                                    9999999                                   Filing Period Ending:                      MMDDYYYY                                                                     13
14                                                                                                                                                                                                                                     14
15 4a. Taxable Gross Income                                                                                                                                                                                                            15
                                                                        999999
16                                                                                                             X        Close Account                  X        Amended Return                   X        Address Change               16
17 5a. Rate of Tax                                                                           7%                                                                                                                    (See Back)          17
18                                                                                                                                                              TAX SUMMARY                                                            18
19 6a. Tax Calculated                                                                                                                                           * Required Fields                                                      19
       To Line 7                                                        999999
20                                                                                                                                                                                                                                     20
21                                                                                                             *7. Tax Due for Tax Codes 12, 13, 14,                                                                                   21
                                                                                                                     15, 28, 56, 59, 65, 70, 73, 74, 83                                                999999
22                                                                                                                                                                                                                                     22
23 1b. TAX CODE (FROM TABLE)                                                                 99                  8.  Excess Collections                                                                999999                          23
24                                                                                                                                                                                                                                     24
25 2b. Gross Income or Sales                                      9999999                                      *9. Balance (Line 7 plus Line 8)                                                        999999                          25
26                                                                                                                                                                                                                                     26
27 3b. Deductions                                                                                               10. Discount (2% of Line 9,                                                                                            27
       (From Schedule on Back)                                    9999999                                            Limited to $50.00 per Return)                                                                    99
28                                                                                                                                                                                                                                     28
                                                                                                                     minus Line 10)
29 4b. Taxable Gross Income                                          999999                                    *11. Balance of Tax Due (Line 9                                                         999999                          29
30                                                                                                                                                                                                                                     30
31 5b. Rate of Tax (From Table)                                                     9.99%                      *12. Tax64,Due71, 72,for80Tax Codes 60, 61,                                             999999                          31
32                                                                                                                                                                                                                                     32
33 6b. Tax Calculated                                                                                          *13. Total Tax Due (Line 11 plus                                                                                        33
       To Line 7, Line 12 or Line 16                                 999999                                          Line 12)                                                                          999999
34                                                                                                                                                                                                                                     34
35                                                                                                             14a. Tax Credit Paid to Alcohol Wholesaler                                                                              35
                                                                                                                                                                                                       999999
36                                                                                                                                                                                                                                     36
37 1c. TAX CODE (FROM TABLE)                                                                                   14b. Tax Credit Paid to Beer Distributor                                                                                37
                                                                                             99                                                                                                        999999
38                                                                                                                                                                                                                                     38
39 2c. Gross Income or Sales                                                                                   14c. Tax Credit for Tax Paid on Items                                                                                   39
                                                                  9999999                                           Purchased for Resale                                                               999999
40                                                                                                                                                                                                                                     40
41 3c. Deductions                                                                                              *15. Total Sales Tax Due (Line 13 Minus                                                                                 41
       (From Schedule on Back)                                    9999999                                            total of lines 14a, 14b & 14c)                                                    999999
42                                                                                                                                                                                                                                     42
43 4c. Taxable Gross Income                                                                                    *16. Special Tax Due 21, 25, 88, 89, 90,                                                                                43
                                                                     999999                                          91, 92, 93, 94, 95, 96, 97, 98, 99                                                999999
44                                                                                                                                                                                                                                     44
45 5c. Rate of Tax (From Table)                                                                                 17.  Discount (2% of Line 16,                                                                                          45
                                                                                    9.99%                            Limited to $50.00 per Return)                                                                    99
46                                                                                                                                                                                                                                     46
47 6c. Tax Calculated                                                                                          *18. Balance of Special Tax Due                                                                                         47
       To Line 7, Line 12 or Line 16                                 999999                                          (Line 16 minus Line 17)                                                           999999
48                                                                                                                                                                                                                                     48
49                                                                                                             *19. Total Sales Tax & Special Tax Due                                                                                  49
                                                                                                                      (Line 15 plus Line 18)                                                           999999
50                                                                                                                                                                                                                                     50
51 1d. TAX CODE (FROM TABLE)                                                                 99                 20.   Penalty                                                                          999999                          51
52                                                                                                                                                                                                                                     52
53 2d. Gross Income or Sales                                                                                    21.   Interest                                                                                                         53
                                                                  9999999                                                                                                                              999999
54                                                                                                                                                                                                                                     54
55 3d. Deductions                                                                                              *22. Total Due (Line 19 plus                                                                                            55
       (From Schedule on Back)                                    9999999                                            Line 20 plus Line 21)                                                             999999
56                                                                                                                                                                                                                                     56
57 4d. Taxable Gross Income                                          999999                                                This form is only for use starting with the July 2022 period.                                               57
58                                                                                                                I declare, under the penalties of perjury, that this return (including any                                           58
   5d. Rate of Tax (From Table)                                                                                   accompanying schedules) has been examined by me and to the best of my 
59                                                                                  9.99%                         knowledge and belief is a true, correct and complete return.                                                         59
60                                                                                                                                                                                                                                     60
61 6d. Tax Calculated                                                                                                                                                                                                                  61
62     To Line 7, Line 12 or Line 16                                 999999                                                                                Signature of Taxpayer or Agent                                              62

63                                                                                                                                                                                                                                     63
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Form 72-010-22-3-2-000 (Rev. 04/22)
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04                                                                                                                                                                                                                              04
05                                                           Mississippi                                                         Page 2                                                                                         05
06    720102232000                         SALES & SPECIAL Tax Return                                                                                                                                                           06
07                                                                                                                                                                                                                              07
08                                         Schedule of Itemized Deductions                                                                                                                                                      08
09                                                                                                                                                                                                                              09
10 1. Sales and Special Tax Included                           6. Sales of Prescription                                                                                                                                         10
                                           9999999                Drugs and Medicines                                 9999999
11                                                                                                                                                                                                                              11
12 2. Wholesale Sales - Sales                                  7. Sales of Motor Fuels                                                                                                                                          12
      for Resale                           9999999                                                                    9999999
13                                                                                                                                                                                                                              13
14 3. Sales to Direct Pay                                      8. Purchases made with                                                                                                                                           14
      Permit Holders                       9999999                SNAP/EBT                                            9999999
15                                                                                                                                                                                                                              15
16 4. Sales to MPC Holders                                     9. Other Non-Taxable                                                                                                                                             16
                                           9999999                Sales                                               9999999
17                                                                                                                                                                                                                              17
18 5. Sales Delivered Outside                                10.  Total Deductions                                                                                                                                              18
      of Mississippi                       9999999                                                                    9999999
19                                                                                                                                                                                                                              19
20                                                                                                                                                                                                                              20
21                                         Prime Contractor Tax Schedule                                                                                                                                                        21
22                                                                                                                                                                                                                              22
23       Material Purchase Certificate Number/               Compensation Received this Month or Amount of Contractor's Tax Due                                                                                                 23
24           Oil and Gas Well Drillers Number                Contract Amount                                          this Month                                                                                                24
25                                                                                                                                                                                                                              25
26    1. XX99999999                                          9999999                                                  9999999                                                                                                   26
27                                                                                                                                                                                                                              27
28    2. XX99999999                                          9999999                                                  9999999                                                                                                   28
29                                                                                                                                                                                                                              29
30    3. XX99999999                                          9999999                                                  9999999                                                                                                   30
31                                                                                                                                                                                                                              31
32    4. XX99999999                                          9999999                                                  9999999                                                                                                   32
33                                                                                                                                                                                                                              33
34    5. XX99999999                                          9999999                                                  9999999                                                                                                   34
35                                                                                                                                                                                                                              35
36    6. Total - To Tax Code 60 on Front                                                                                                                                                                                        36
         (Line 2b, 2c, or 2d)                                9999999                                                  9999999
37                                                                                                                                                                                                                              37
38                                                                                                                                                                                                                              38
39                                                                                                                                                                                                                              39
40    1. XX99999999                                          9999999                                                  9999999                                                                                                   40
41                                                                                                                                                                                                                              41
42    2. XX99999999                                          9999999                                                  9999999                                                                                                   42
43                                                                                                                                                                                                                              43
44    3. XX99999999                                          9999999                                                  9999999                                                                                                   44
45                                                                                                                                                                                                                              45
46    4. XX99999999                                          9999999                                                  9999999                                                                                                   46
47                                                                                                                                                                                                                              47
48    5. XX99999999                                          9999999                                                  9999999                                                                                                   48
49                                                                                                                                                                                                                              49
50    6. XX99999999                                          9999999                                                  9999999                                                                                                   50
51                                                                                                                                                                                                                              51
52    7. XX99999999                                          9999999                                                  9999999                                                                                                   52
53                                                                                                                                                                                                                              53
54    8. XX99999999                                          9999999                                                  9999999                                                                                                   54
55                                                                                                                                                                                                                              55
56    9. XX99999999                                          9999999                                                  9999999                                                                                                   56
57                                                                                                                                                                                                                              57
58    10. Total - To Tax Code 61 on Front                                                                                                                                                                                       58
         (Line 2b, 2c, or 2d)                                9999999                                                  9999999
59                                                                                                                                                                                                                              59
60                                                           X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X                                                                                                                                60
61                                 If Change of Address      Mailing Address (Number & Street, Including Rural Route)                                                                                                           61
                                   is marked on front, list  
62                                 new address here:         XXXXXXXXXXXXXXXXXXXXXXXXX XX                                        99999                                                                                          62
63                                                           City                                                     State      Zip                                                                                            63
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  Form 72-010-22-3-3-000 (Rev. 04/22)
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04                                                                  Mississippi                                                                                                                                                   04
05                                                                                                                                                                                                                                05
06                                                             Sales & Special Tax Return                                                                                                                                         06
  DO NOT STAPLE THIS RETURN
07                                                                                                                                                                                                                                07
08                                                                  Instructions                                                                                                                                                  08
09                                                                                                                                                                                                                                09
10Filling in the return                                                       Tax Summary                                                                                                                                         10
11                                                                                                                                                                                                                                11
12 Use black ink when preparing your return. Print your numbers like this:    Line 7                                                                                                                                              12
                                                                              Enter the Total of Lines 6a, 6b, 6c, and 6d for tax categories to which the 
13              1 0 0 0 - 1 2 3 4                                             vendor discount applies(Tax Codes 12, 13, 14, 15, 28, 56, 59, 65, 70, 73, 13
14                                                                            74 and 83). Please exclude sales from tax code 60 and 61.                                                                                           14
15Sending in the return                                                       Line 8                                                                                                                                              15
16                                                                            Enter Excess Collections.                                                                                                                           16
17 Include this return and your check or money order for the amount on Line                                                                                                                                                       17
18 22 to the Department of Revenue,P.O. Box 960, Jackson, MS 39205.           Line 9                                                                                                                                              18
19                                                                            Line 7 plus Line 8.                                                                                                                                 19
20Account Number                                                                                                                                                                                                                  20
21                                                                            Line 10                                                                                                                                             21
22 If your return does not have your account number preprinted, enter your    Enter the result of Line 9 multiplied by 2%.  This amount is limited to                                                                             22
   account number in the field provided beneath the area for your name.
23                                                                            $50 per return.  The Vendor Discount is not allowed if your return is                                                                               23
                                                                              not filed and paid on time.
24                                                                                                                                                                                                                                24
25Filing Period                                                                                                                                                                                                                   25
                                                                              Line 11
26                                                                            Line 9 minus line 10.                                                                                                                               26
   Enter the month, last day of the month, and year this return  
27 covers in the boxes using numbers to indicate the month and year.                                                                                                                                                              27
28 For example, September, 2021 would be entered as                           Line 12                                                                                                                                             28
29                                                                            Enter the Total of Lines 6a, 6b, 6c, and 6d for tax categories to which the 29
   Filing Period Ending:                                                      vendor discount doesn't apply(Tax Codes 60, 61, 64, 71, 72, and 80).
30                                                  0 9 3 0 2 0 2 2                                                                                                                                                               30
31                                   m m d        d        y y y y            Line 13                                                                                                                                             31
32                                                                            Enter the total of Line 11 plus Line 12.                                                                                                            32
   Quarterly and annual filers will enter their period the same way.
33                                                                                                                                                                                                                                33
34                                                                            Line 14a                                                                                                                                            34
35Tax Categories                                                              Enter the amount of wholesale tax paid on alcohol.                                                                                                  35
36                                                                                                                                                                                                                                36
37 The Sales & Special Tax Return is divided into four Tax Category           Line 14b                                                                                                                                            37
   sections and a Tax Summary section. The Tax Category sections are 
38 used to report your sales, deductions and tax by the category in which     Enter the amount of wholesale tax paid on beer.                                                                                                     38
39 they occurred. Use only as many Tax Category sections as you have                                                                                                                                                              39
40 different categories. If you need to report more than four tax categories, Line 14c                                                                                                                                            40
   you will need to file on TAP.                                              Enter the Tax Credit of items purchased for resale or other states' tax 
41                                                                            on interstate telecommunications only.                                                                                                              41
42 Lines 1a, 1b, 1c, and 1d                                                                                                                                                                                                       42
43 Enter the Tax Code from the Tax Category Table that is assigned to the     Line 15                                                                                                                                             43
44 category of tax you are reporting. Only one Tax Code should be used for    Enter the total of Line 13 minus Lines 14a, 14b and 14c.                                                                                            44
45 each Tax Category.                                                                                                                                                                                                             45
46                                                                            Line 16                                                                                                                                             46
47 Lines 2a, 2b, 2c, and 2d                                                   Enter the total of Lines 6a, 6b, 6c, and 6d for tax categories representing                                                                         47
                                                                              a SPECIAL or SPECIAL CITY tax levy(Tax Codes 21, 25, 88, 89, 90, 91, 
48 Enter the total gross sales or for the category of tax you are reporting.  92, 93, 94, 95, 96, 97, 98, and 99).                                                                                                                48
49                                                                                                                                                                                                                                49
50 Lines 3a, 3b, 3c, and 3d                                                   Line 17                                                                                                                                             50
51 Enter Deductions by Tax Rate, that corresponds with the Schedule of        Enter the result of Line 16 multiplied by 2%.  This amount is limited to                                                                            51
52 Deductions on the back of the return.                                      $50 per return. The Vendor Discount(effective 3/01/2013) is not allowed                                                                             52
53                                                                            if your return is not filed and paid on time.                                                                                                       53
54 Lines 4a, 4b, 4c, and 4d                                                                                                                                                                                                       54
55 Lines 2a, 2b, 2c, and 2d minus Lines 3a, 3b, 3c, and 3d.                   Line 18                                                                                                                                             55
                                                                              Enter the total of Line 16 minus Line 17.
56                                                                                                                                                                                                                                56
57 Lines 5a, 5b, 5c, and 5d                                                                                                                                                                                                       57
                                                                              Line 19
58 Enter the Tax Rate from the Tax Category Table that corresponds to         Enter the total of Line 15 plus Line 18.                                                                                                            58
59 the category of tax you are reporting.                                                                                                                                                                                         59
60                                                                            Line 20                                                                                                                                             60
61 Lines 6a, 6b, 6c, and 6d                                                   Enter the applicable 10% penalty if the return is filed late.                                                                                       61
62 Lines 4a, 4b, 4c, and 4d multiplied by the rates on Lines 5a, 5b, 5c, and                                                                                                                                                      62
   5d.
63                                                                                                                                                                                                                                63
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Form 72-010-22-3-4-000 (Rev. 04/22)
06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38Mississippi39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
04                                                                                                                                                                                                                                              04
05                                                                                           Sales & Special Tax Return                                                                                                                         05
DO NOT STAPLE THIS RETURN
06                                                                                                                Instructions                                                                                                                  06
07 Line 21                                                                                                                       PRIME CONTRACTOR TAX SCHEDULE                                                                                  07
08 Enter the applicable interest from the due date of the return if the return                                                      All contractors who have qualified a construction contract with the                                         08
   is filed late:                                                                                                                   Department of Revenue must complete this schedule. Persons or firms  
09                                                                                                                                  domiciled outside Mississippi are required to qualify and pay the 1 1/2%                                    09
10 Before January 1, 2015:  1%                                                                                                      and the 3 1/2% contractor's tax due on the total contract amount before                                     10
11 January 1, 2015-December 31st, 2015: 9/10 of 1%                                                                                  work is begun unless a surety bond is filed as provided by Section                                          11
   January 1, 2016-December 31st, 2016: 8/10 of 1%                                                                                  27-65-21 in an amount sufficient to ensure payment of such taxes.
12 January 1, 2017-December 31st, 2017: 7/10 of 1%                                                                                                                                                                                              12
13 January 1, 2018-December 31st, 2018: 6/10 of 1%                                                                                  The first section of the schedule applies only to contracts subject to the                                  13
   After January 1, 2019: 1/2 of 1%                                                                                                 1 1/2% rate. The second section of the schedule applies only to contracts 
14                                                                                                                                  subject to the 3 1/2% rate. If a contract includes both rates of tax, the                                   14
15 Line 22                                                                                                                          contract must be entered in both sections of the schedule. The totals of                                    15
16 Enter the net total of Lines 19, 20, and 21. This is the amount you                                                              lines 6 and 10 for each rate should be transferred to the appropriate Tax                                   16
17 should pay.                                                                                                                      Category section of the front of the return.                                                                17
                                                                                                                                 MPC# / Oil and Gas Well Driller # Column
18                                                                                                                                  Identify each tax payment with the complete 10-digit Material Purchase                                      18
SCHEDULE OF ITEMIZED DEDUCTIONS
19                                                                                                                                  Number(MPC) or Oil or Gas Well Driller Number. The first two characters 19
   Line 1
20                                                                                                                                  should be alpha characters(such as BB or PD). The next eight characters  20
   Record sales and special tax included.
21                                                                                                                                  should be numeric characters(such as 12345678). Example:                                                    21
   Line 2 through Line 8
22                                                                                                                                        B B  1 2 3 4 5 6  7 8                                                                                 22
   Record all sales not subject to Mississippi Sales Tax on the line 
23 that most closely describes the type of sale. For example, sales                                                              Compensation Received Column                                                                                   23
                                                                                                                                    If the tax is guaranteed by surety bond or the amount of the contract is 
24 of prescription drugs should be recorded on Line 6.                                                                              $75,000 or less, report the amount of progress payment received during                                      24
25                                                                                                                                  the month.  Also, report the amount of progress payments on prepaid                                         25
   Line 9
26 Record all sales not subject to Mississippi Sales Tax that do not                                                                contracts if the contract has exceded the original contract amount.                                         26
27 fit one of the types of sales on Lines 2 through 8.                                                                           Amount of Contractor's Tax Due Column                                                                          27
28                                                                                                                                  Enter the tax due on the amount of Compensation Received Column.                                            28
   Line 10
29                                                                                                                                  If you have any questions, please contact your local District Service                                       29
   Enter the total of Lines 1 through 9. Transfer this total to Line 3a, 
30 3b, 3c, or 3d in the Tax Category sections on the front of the return.                                                           Office.  The contact information can be found on our website,                                               30
31 The total should be split among the applicable rates of tax.                                                                     www.dor.ms.gov.                                                                                             31
32                                                                                                          TAX CATEGORY TABLE                                                                                                                  32
33                                                                            Tax Category                     TAX CATEGORY TABLE                                    Tax Code                   Tax Rate              Vendor Discount           33
34 General Sales Tax Rate                                                                                                                                                  74                      7%                       Yes                 34
35 Trucks (greater than 10,000 lbs.), Mobile Homes and Aircraft                                                                                                            13                      3%                       Yes                 35
36 Rental of Trucks (greater than 10,000 lbs.)                                                                                                                             14                      3%                       Yes                 36
37 Amusement for Public Owned Coliseums & Auditoriums                                                                                                                      15                      3%                       Yes                 37
38 Autos, Motor Homes, Light Trucks (10,000 lbs. or less).                                                                                                                 56                      5%                       Yes                 38
39 Rental of autos, light trucks (10,000 lbs. or less).                                                                                                                    59                      5%                       Yes                 39
40 Electric Power Associations                                                                                                                                             12                      1%                       Yes                 40
41 Manufacturing Machinery, Industrial Fuel, Farm Tractors,  Farm Implements, including replacement parts                                                                  65                   1 1/2%                      Yes                 41
42 Sales or Construction of Floating Vessels - Non-Transportation                                                                                                          28                   3 1/2%                      Yes                 42
43 Contracting - Manufacturing                                                                                                                                             60                   1 1/2%                         No               43
44 Contracting - Commercial, Non Residential                                                                                                                               61                   3 1/2%                         No               44
45 Public Utilities - Non-Residential Consumer Sales                                                                                                                       71                      7%                          No               45
46 Wholesale - Beer and Whiskey                                                                                                                                            72                      7%                          No               46
47 Wholesale - Food and Drinks - Full Service Vending                                                                                                                      64                      8%                          No               47
48 Interstate Telecommunications                                                                                                                                           80                      7%                          No               48
49 Jackson 1% Infrastructure Tax                                                                                                                                           21                      1%                       Yes                 49
50 Tupelo Special City Tax                                                                                                                                                 25                   1/4%                        Yes                 50
51 1% Hotel/Restaurant Special Tax                                                                                                                                         89                      1%                       Yes                 51
52 1% Restaurant Tax                                                                                                                                                       90                      1%                          Yes              52
53 1% Special Tax                                                                                                                                                          91                      1%                       Yes                 53
54 2% Special Tax                                                                                                                                                          92                      2%                       Yes                 54
55 2% Special Tax                                                                                                                                                          93                      2%                       Yes                 55
56 2% Special Tax                                                                                                                                                          88                      2%                       Yes                 56
57 3% Special Tax                                                                                                                                                          94                      3%                       Yes                 57
58 4% Special Tax                                                                                                                                                          95                      4%                       Yes                 58
59 5% Special Tax                                                                                                                                                          96                      5%                       Yes                 59
60 1 1/2% Special Tax                                                                                                                                                      97                   1 1/2%                      Yes                 60
61 2 1/2% Special Tax                                                                                                                                                      98                   2 1/2%                      Yes                 61
62 2% Hotel Special Tax                                                                                                                                                    99                      2%                       Yes                 62
63 Casino Hotels                                                                                                                                                           70                      7%                       Yes                 63
06 07Casino08 09 10 11Restaurants12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 667%67 68 69 70 71 72 73 74 75 76 77 78 79 80
                                                                                                                                                                           73                                                  Yes
   Medical Cannabis Tax                                                                                                                                                    83                      7%                          Yes