1. One form per individual, regardless of marital or filing status.
2. Payment in the amount of $10.00 must be received prior to the request being
processed. Payment will only be accepted in the form of cashier’s check or
money order. Personal checks for tax transcript requests will not be accepted.
3. Request forms and payment should be mailed to:
Mississippi Department of Revenue
Individual Income Tax Transcript Request
P.O. Box 1033
Jackson, MS 39215-1033
4. All of the requested information must be provided on the request form. Any
request form lacking the required information will not be processed.
5. If the requested information is not applicable to the taxpayer, please indicate
this by inserting N/A in the appropriate space.
6. Notarization is not required if the tax transcript is to be provided only to the
taxpayer.
7. Notarization is required for the tax transcript to be sent to anyone other than the
taxpayer.
8. Only request forms received by mail, with an original signature will be
processed. (Faxed forms are not acceptable.)
9. Tax Transcripts are only provided for proof of individual income tax filing.
MISSISSIPPI
DEPARTMENT OF REVENUE
Tax Transcript Request
Post Office Box 1033
Jackson, MS 39215-1033
INSTRUCTIONS
Form 80-700
Individual Income Tax Division
500 Clinton Center Drive
Clinton, MS 39056
Individual Income Tax Division P.O. Box 1033 Jackson, MS 39215 www.dor.ms.gov Phone: 601-923-7700 Fax: 601-923-7039
TAX TRANSCRIPT REQUEST
Form 80-700
I would like to request a tax transcript certifying that I filed Mississippi Individual Income Tax Returns for the last four years.
FULL NAME:
ADDRESS:
CITY, STATE, ZIP CODE:
SOCIAL SECURITY NUMBER:
SIGNATURE:
______________________________________________
______________________________________________
______________________________________________
__________________________________
____________________________________ DATE: _____________
In order to process this request, you must provide the following information for each tax year requested:
Tax year Filing Status* Full Legal Name of Joint Filer
________ ____________ _________________________________________
________ ____________ _________________________________________
________ ____________ _________________________________________
________ ____________ _________________________________________
Joint Filer’s Social Security #
_____________________
_____________________
_____________________
_____________________
*Filing Status – i.e.: (S) Single, (MFJ) Married Filing Joint Return, (MFS) Married Filing Separate Return, (HOF) Head of
Family, (W) Widowed
If you wish for your tax transcript to be sent by mail to anyone other than yourself, please provide their information below.
For information to be released to a third party, this form must be notarized.
NAME: ______________________________________________
ADDRESS: ______________________________________________
CITY, STATE, ZIP CODE: ______________________________________________
Please send my tax transcript to the person indicated above. I understand that by requesting my tax transcript to be sent to a third
party, I am waiving the confidentiality provisions of §27-3-73 and §27-7-83 of the Mississippi Code of 1972.
SIGNATURE: _____________________________________________________ DATE: _______________________________
SWORN AND SUBSCRIBED BEFORE ME THIS THE __________DAY OF _______________________________, 20____.
My Commission Expires:
_______________________ __________________________________________
NOTARY PUBLIC
SEAL
Payment of $10.00 must be submitted before this request will be processed. Payment must be in the form of cash, cashier’s check, or
money order. We do not accept personal checks for tax transcript requests. Please allow ten business days for processing.
The Department of Revenue certifies that, as of this date, this information is true and correct based upon the information provided
by the taxpayer. In the event that the taxpayer supplied erroneous or incomplete information, this transcript is subject to
review/amendment by the Department of Revenue.
