Form0606 0707 08071-661-22-3-1-00009 10 11 12 13 14 15(Rev.16 1707/22)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 0505
Installment Agreement
0606 0606
0707 MUST BE ATTACHED TO FRONT OF RETURN 0707
0808 DO NOT file this form if you are currently making payments on an installment agreement. If you are in bankruptcy, see instructions. 0808
0909 0909
1010 Taxpayer First Name Initial Last Name SSN 1010
999999999
1111XXXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXX 1111
1212 Spouse First Name Initial Last Name Spouse SSN 999999999 1212
1313XXXXXXXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXX 1313
1414 Mailing Address (Number and Street, Including Rural Route) 1414
1515 If this address is new since you filed 1515
1616X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X City State Zip County Code your last tax return, check here: X 1616
1717XXXXXXXXXXXXXXXXXXXXX XX 99999 99 1717
1818 Phone Number Extension Best Time to Call 1818
1919(999)999-9999 9999 X9X9X9X9X9X9X9X9X9X9X9X9 1919
2020 2020
2121 Banking Information Employer Information 2121
2222 2222
2323 Name of your bank or other financial institution Your employer's name 2323
2424X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X2424
2525 Address Address 2525
2626X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9 X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X9X2626
2727 City, State, Zip Code City, State, Zip Code 2727
2828XXXXXXXXXXXXXXXXXXXXX XX 99999 XXXXXXXXXXXXXXXXXXXXX XX 99999 2828
2929 2929
3030 Payment Information 3030
3131 3131
3232 1 Enter the tax year for which you are making this request 1 9999 3232
3333 3333
3434 2 Enter the total amount you owe (as shown on your return) 2 9999999999 3434
3535 3535
3636 3 Enter the amount of any payment you are making with your tax return (see instructions) 3 9999999999 3636
3737 3737
3838 4 Enter the amount due each month (interest will continue until you pay in full) 4 9999999999 3838
3939 3939
4040 Instructions 4040
4141An installment agreement is available to taxpayers that have a tax liability of at least $75. In order to qualify for the installment agreement, the return 4141
4242must be filed on or before the due date, or any extensions allowed, and this request form must be submitted with the return. You (and your spouse if a 4242
4343joint return) must have filed all required income tax returns and paid all taxes due for the past five years. You also can not have previously entered 4343
into an installment agreement during the past five years.
4444 4444
4545 4545
4646There are two (2) types of installment agreements for taxpayers that have a tax liability: 4646
4747 4747
4848 (1) Tax liability of $75 but no more than $3,000 - The installment agreement allows you to pay the amount due in twelve equal installments. 4848
4949 4949
5050 (2) Tax liability exceeding $3,000 and an installment agreement with the Internal Revenue Service (IRS) for the same tax year. The installment 5050
agreement allows you to pay the amount due within sixty months. You must attach a copy of the approved installment agreement
5151 notification from the IRS. 5151
5252 5252
5353 5353
5454• The agreement may be terminated if any installment payment is not made timely. It may also be terminated if you do not pay any other tax liability 5454
5555when the liability is due. 5555
5656• Interest of 1/2 % per month continues to accrue during the installment agreement period. You will need to contact our office for the remaining balance 5656
5757on the account prior to the last payment to ensure the interest is paid correctly. 5757
5858 5858
• If you have a pending bankruptcy case, you may be barred by federal law from participation in an installment agreement. Please contact our office for
5959more details. Additionally, if you file bankruptcy during the installment period, you must notify our Bankruptcy Section immediately at 601-923-7393. 5959
6060Due to the automatic stay provisions of the U.S. Bankruptcy Code, the installment agreement may be void at the time you file your bankruptcy case. 6060
6161 6161
6262 6262
6363 Mail To: Department of Revenue, P.O. Box 23050, Jackson, MS 39225-3050 6363
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