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Form 83-391-23-3-1-000 (Rev. 01/24) 0606 0707 080 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 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 66 67 68 69 70 71 72 73 74 75 76 77 78 79 808 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 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 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 0404 Mississippi 0404 0505 Insurance Company Income Tax Return 0505 0606 833912331000 2023 0606 0707 0707 0808 Tax Year Beginning 99999999 Tax Year Ending 99999999 0808 0909 0909 1010 FEIN 999999999 Mississippi Secretary of State ID 9999999999 1010 1111 1111 1212 Legal Name and DBA CHECK ALL THAT APPLY 1212 1313 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9 1313 1414 Address X Amended Return X Accident and Health 1414 1515 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9 1515 1616 X Final Return X Fire and Casualty 1616 1717 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9 1717 1818 City State Zip +4 Life Insurance 1818 X 1919 X9X9X9X9X9X9X9X9X9X9X9X9X9X9 XX 999999999 X Accrual Basis 1919 2020 2020 2121 County Code 99 NAICS Code 999999 X Receipts and 2121 2222 Disbursements Basis 2222 2323 COMPUTATION OF TAX (ROUND TO THE NEAREST DOLLAR) 2323 2424 2424 2525 X Combined income tax return (enter FEIN of reporting company) 999999999 2525 2626 2626 2727 1 Mississippi net taxable income (from page 2, line 17A or Form 83-310, page 1, line 5, column C) 1 99999999999 2727 2828 2828 2929 2 Income tax 2 9999999999 2929 3030 3030 3131 3 Retaliatory taxes paid to other states (Mississippi corporations only; from page 4, part V, line 1) 3 9999999999 3131 3232 3232 3333 4 Income tax credits (from Form 83-401, line 3 or Form 83-310, page 1, line 5, column B) 4 9999999999 3333 3434 3434 3535 5 Net income tax due (line 2 minus line 3 and line 4) 5 9999999999 3535 3636 3636 3737 PAYMENTS AND TAX DUE 3737 3838 3838 3939 6 Overpayment from prior year 6 9999999999 3939 4040 4040 4141 7 Estimated tax payments and payment with extension 7 9999999999 4141 4242 4242 4343 8 Total payments (line 6 plus line 7) 8 9999999999 4343 4444 4444 4545 9 Net total income tax due (line 5 minus line 8) 9 9999999999 4545 4646 4646 4747 10 Interest and penalty on underestimated income tax payments (from Form 83-305, line 19) 10 9999999999 4747 4848 4848 4949 11 Late payment interest 11 9999999999 4949 5050 5050 5151 12 Late payment penalty 12 9999999999 5151 5252 5252 5353 13 Late filing penalty (minimum $100) 13 9999999999 5353 5454 5454 5555 14 Total balance due (if line 5 is larger than line 8, add lines 9 through 13) 14 9999999999 5555 5656 5656 5757 15 Total overpayment (if line 8 is larger than line 5, subtract line 5 from line 8) 15 9999999999 5757 5858 5858 5959 16 Total overpayment credited to next year (from line 15) 16 9999999999 5959 6060 6060 6161 17 Total overpayment refunded (line 15 minus line 16) 17 9999999999 6161 6262 6262 6363 6363 0606 0707 080 09 10 11 12 13 14 15 16 17See instructions for electronic payment options or attach check or money order for balance due.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 66 67 68 69 70 71 72 73 74 75 76 77 78 79 808 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 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 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80
