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Form 83-115-23-3-1-000 (Rev. 11/23)
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04 Mississippi 04
05 Corporate Income Declaration for Electronic Filing 05
MS8453-C
06 2023 06
07 07
08Tax Year Beginning 99999999 Tax Year Ending 99999999 08
09 DO NOT MAIL THIS DOCUMENT 09
10FEIN 999999999 TO THE DEPARTMENT OF REVENUE 10
11 11
12 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X 12
13Legal Name and DBA 13
14 X9X9X9X9X9X9X9X9X9X9X9X9X9X X9X9X9X9X9X9X9X9X XX 999999999 99 14
15Address City State Zip +4 County Code 15
16 16
17 PART I: TAX RETURN INFORMATION (ROUND TO THE NEAREST DOLLAR) 17
18 18
191 Mississippi taxable income (Form 83-105, line 5) 1 9999999999 19
202 Total income tax (Form 83-105, line 6) 2 9999999999 20
213 Total credits and payments (Form 83-105, line 7 and line 13) 3 9999999999 21
224 Amount you owe (Form 83-105, line 19) 4 9999999999 22
235 Overpayment (Form 83-105, line 20) 5 9999999999 23
246 Refund (Form 83-105, line 22) 6 9999999999 24
257 Amount of payment remitted electronically 7 9999999999 25
26 26
27* If the corporation is filing a balance due return and the Department of Revenue does not receive full and timely payment of its tax liability, 27
28 the corporation will be liable for the tax liability and all applicable interest and penalties. 28
29 29
30 PART II: DECLARATION OF OFFICER 30
31 31
32Under the penalties of perjury, I declare that I am an officer of the above corporation and that the information I have given my electronic return originator (ERO), transmitter,32
and/or intermediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding lines of the corporation's Mississippi Corporate
33Income and Franchise Tax Return. To the best of my knowledge and belief, the corporation's return is true, correct and complete. I consent to my ERO, transmitter, and/or ISP33
34sending the corporation's return, this declaration, and accompanying schedules and statements to the Department of Revenue (DOR). I also consent to the DOR my ERO,34
transmitter, and/or ISP an acknowledgement of receipt of transmission and an indication of whether or not the corporation's return is accepted, and, if rejected, the reason(s)
35for the rejection. This declaration is to be maintained by the ERO and provided to DOR on request. 35
36Sign Signature of Officer Date Title 36
37Here 37
38 38
39 PART lll: DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER 39
40 40
41I declare that I have reviewed the above corporation's return and that the entries on Form MS8453-C are complete and correct to the best of my knowledge. If I am only a 41
collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The corporate officer will have signed this form
42before I submit the return. I will give the officer a copy of all forms and information to be filed with the Department of Revenue (DOR), and have followed all other requirements 42
43in Pub. 3112, IRS e-file Application and Participation and Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers. If I am also the Paid Preparer, 43
under penalties of perjury, I declare that I have examined the above corporation's return and accompanying schedules and statements, and to the best of my knowledge and
44belief, they are true, correct and complete. This Paid Preparer declaration is based on all information of which I have any knowledge. 44
45 45
46 ERO ERO Signature Date Check if Also Check if Self- ERO SSN or PTIN 46
Use Paid Preparer X Employed X
47 Only 9X9X9X9X9 47
48 Firm Name (or yours if EIN 48
self-employed), address
49 and ZIP code X9X9X9X9X9X9X9 X9X9X9X9X9X9X9 XX 99999 999999999 49
50 Phone No. 50
51 (999)999-9999 51
52 52
53 53
54Under penalties of perjury, I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and 54
belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.
55 55
56 56
57 Paid Preparer Signature Date Check if Also X Check if Self- X Preparer SSN or PTIN 57
Paid Preparer Employed
58 Preparer 9X9X9X9X9 58
Use Only
59 Firm Name (or yours if EIN 59
self-employed), address
60 and ZIP code X9X9X9X9X9X9X9 X9X9X9X9X9X9X9 XX 99999 999999999 60
61 Phone No. 61
62 (999)999-9999 62
63 63
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DO NOT Mail this Document to the Mississippi Department of Revenue