Form 83-450-23-3-1-000 (Rev. 10/23)
                                                                    Mississippi
FEIN                                                                                                                                                  Page 1
      999999999                                                     New Jobs Credit

Name: X9X9X9X9X9X9X9X9X9X9X9X9X9X9X              Facility Location: X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9                                  County X9X9X9X9X9X9X9X9X9

1  List the number of full time employees subject to Mississippi withholding at this facility at the end of each month.

      Month                        9999  9999    9999    9999       9999    9999                                       9999   9999    9999    9999    9999
                        Base Year        Year 1  Year 2  Year 3     Year 4  Year 5                                     Year 6 Year 7  Year 8  Year 9  Year 10
1
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
2
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
3
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
4
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
5
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
6
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
7
 XXXXXXXXX              999999           999999  999999  999999     999999  999999  999999                                    999999  999999  999999  999999
8
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
9
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
10
  XXXXXXXXX             999999           999999  999999  999999     999999  999999  999999                                    999999  999999  999999  999999
11
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
12
  XXXXXXXXX             999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
 2     Total employees
                        999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
 3     Number of months 
        in operation    999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
 4     Average of full- 
        time employees  999999           999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
 5     Less prior year average
                                         999999  999999  999999     999999  999999                                     999999 999999  999999  999999  999999
 6     Average increase in full-time  
        employees (enter also on page 2, 
        line 7)
                                         9999999 9999999 9999999    9999999 9999999 9999999                                   9999999 9999999 9999999 9999999

Form 83-450-23-3-2-000 (Rev. 10/23)

FEIN 999999999                                                         Mississippi                                     Page 2
                                                                       New Jobs Credit

Computation of eligible credit         9999            9999    9999    9999    9999    9999    9999    9999    9999                                                                                   9999
                                                Year 1 Year 2  Year 3  Year 4  Year 5  Year 6  Year 7  Year 8  Year 9                                                                                 Year 10
7     Average increase in full-time
       employees (from page 1, line 6) 9999999         9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999

8     Year 1 increase (line 7)                         9999999 9999999 9999999 9999999 9999999

9     Year 2 increase (line 7)                                 9999999 9999999 9999999 9999999 9999999

10   Year 3 increase (line 7)                                          9999999 9999999 9999999 9999999 9999999
11   Year 4 increase (line 7)
                                                                               9999999 9999999 9999999 9999999 9999999

12   Year 5 increase (line 7)                                                          9999999 9999999 9999999 9999999 9999999

13   Year 6 increase (line 7)                                                                  9999999 9999999 9999999 9999999

14   Year 7 increase (line 7)                                                                          9999999 9999999 9999999

15   Year 8 increase (line 7)                                                                                  9999999 9999999

16   Year 9 increase (line 7)                                                                                          9999999
17   Number of new jobs eligible for 
       credit (add Lines 8 through 16)                 9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999

18   Amount of payroll for new jobs (from line 17)     9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999
19   Percentage of payroll for new jobs in county tier
                                                       99.99   99.99   99.99   99.99   99.99   99.99   99.99   99.99   99.99
20   Eligible credit for percentage of payroll  
       (multiply line 18 by line 19)                   9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999 9999999

A current year decrease in employment (Line 7) will reduce Number of New Jobs Eligible for Credit (Line 17) for the current year.  This is in contrast to an increase of employment in which the increase is 
delayed a year.  A qualifying level of increase of employment must be in a single reporting period.  An employer may not combine two or more periods of increases in employment to qualify for a  certain 
level of employment.  A period is assumed to be a full fiscal or calender year.  For additional information, see Title 35, Part X, Chapter 01 of the Mississippi Administrative Code for Limitations. Attach a 
schedule listing new full-time jobs created (title, date created and payroll amount for each year). Attach this form, and the Income Tax Credit Summary (Form 83-401), to your return.