9999        Year 10
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                Page 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             9999999

                                                                                                                                                                                                                                                                             9999        Year 9
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   9999999
                                                                                                                                   X9X9X9X9X9X9X9X9X9

                                                                                                                                                                                                                                                                             9999        Year 8
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                   County                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          9999999

                                                                                                                                                                                                                                                                             9999        Year 7
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   9999999

                                                                                                                                                                                                                                                                             9999        Year 6
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   9999999

                                                                                                                                                                                                                                                                             9999        Year 5
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999                                                                                                                                                                                      9999999

                                    Mississippi                                                                                                                                                                                                                              9999        Year 4
                                                                 New Jobs Credit                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999                                                                                                                                                                                                                                                                                                                                                                                                                                        9999999
                                                                                                                                                                                                                                                                                                                                                                                                                                  999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                   X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9

                                                                                                                                                                                                                                                                             9999        Year 3
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   9999999
                                                                                 Facility Location:

                                                                                                                                                                                                                                                                             9999        Year 2
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999                                                                                                                                                                                      9999999

                                                                                                                                                                                                                                                                             9999               Year 1
                                                                                                                                                                                                                                                                                                        999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999                                999999                                                                                                                                                                                      9999999

                                                                                                                                                                                                                                                                             9999
                                                                                                                                                                                                                                                                                         Base Year      999999      999999      999999      999999      999999      999999      999999      999999      999999       999999       999999      999999                                 999999                                                               999999                                                                 999999

                                                       999999999                                   X9X9X9X9X9X9X9X9X9X9X9X9X9X9X                                                                                                                                                 Month
                                                                                                                                                                                                                                                                                                        XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX   XXXXXXXXX    XXXXXXXXX    XXXXXXXXX          XXXXXXXXX
                                                                                                                                                                                                                                                                                                      1           2           3           4           5           6           7           8           9           10           11           12
Form 83-450-22-3-1-000 (Rev. 04/22)             FEIN                             Name:                                                               1  List the number of full time employees subject to Mississippi withholding at this facility at the end of each month.                                                                                                                                                                                   2     Total employees                          3     Number of months         in operation                          4     Average of full-         time employees         5     Less prior year average                                        6     Average increase in full-time                                                   employees (enter also on page 2,                        line 7)

                                                                         9999                          Year 10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       99.99                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Attach a 
                                    Page 2                                                                                                         9999999                                                                                                                                                                                                                        9999999                               9999999                               9999999                               9999999                               9999999                                                                                                          9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 9
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                                                                                                                                                  9999999                               9999999                               9999999                               9999999                               9999999                                                                                                                                                9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 8
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                                                                                                            9999999                               9999999                               9999999                               9999999                               9999999                                                                                                                                                                                      9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 7
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                                                                      9999999                               9999999                               9999999                               9999999                               9999999                                                                                                                                                                                                                            9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 6
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                               9999999                                9999999                               9999999                               9999999                               9999999                                                                                                                                                                                                                                                                  9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                               9999999                                9999999                               9999999                               9999999                                                                                                                                                                                                                                                                                                        9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                    Mississippi                          9999                          Year 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                         New Jobs Credit                                                                           9999999                                                               9999999                                9999999                               9999999                                                                                                                                                                                                                                                                                                                                              9999999                                                    9999999                                                                                                                                                                                                                                9999999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
                                                                         9999                          Year 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                               9999999                                9999999                                                                                                                                                                                                                                                                                                                                                                                    9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     99.99
                                                                                                                                                   9999999                                                               9999999                                                                                                                                                                                                                                                                                                                                                                                                                           9999999                                                    9999999                                                                                                                                                                                                                                9999999

                                                                         9999                          Year 1
                                                                                                                                                   9999999

                                                999999999
                                                                         Computation of eligible credit
                                                                                                               7     Average increase in full-time        employees (from page 1, line 6) 8     Year 1 increase (line 7)         9     Year 2 increase (line 7)         10   Year 3 increase (line 7)         11   Year 4 increase (line 7)         12   Year 5 increase (line 7)         13   Year 6 increase (line 7)         14   Year 7 increase (line 7)         15   Year 8 increase (line 7)         16   Year 9 increase (line 7)                                      17   Number of new jobs eligible for        credit (add Lines 8 through 16)         18   Amount of payroll for new jobs (from line 17)         19   Percentage of payroll for new jobs in county tier                                                 20   Eligible credit for percentage of payroll                                             (multiply line 18 by line 19)
Form 83-450-22-3-2-000 (Rev. 04/22)             FEIN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                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.                                                                                                                                                                                       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.