Mississippi Pass-Through Entity Declaration for Electronic Filing

Pass-Through Entity Declaration for Electronic Filing
84115238.pdf
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Form 84-115-23-8-1-000 (Rev. 11/23)

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Mississippi

MS8453-PTE

Pass-Through Entity Declaration for Electronic Filing
2023
Tax Year Ending

Tax Year Beginning
mm dd yyyy

mm dd yyyy

DO NOT MAIL THIS DOCUMENT
TO THE DEPARTMENT OF REVENUE

FEIN

Legal Name and DBA

Address

City

State

PART I: TAX RETURN INFORMATION
1
2
3
4
5

Zip +4

County Code

(ROUND TO THE NEAREST DOLLAR)

Mississippi taxable income (Form 84-105, line 5)
Total income tax (Form 84-105, line 6)
Total credits and payments (Form 84-105, line 7 and line 13)
Amount you owe (Form 84-105, line 19)
Overpayment (Form 84-105, line 20)

.00
.00
.00
.00
.00
.00
.00

1
2
3
4
5
6
7

6 Refund (Form 84-105, line 22)
7 Amount of payment remitted electronically

* If the pass-through entity is filing a balance due return and the Department of Revenue does not receive full and timely payment of its tax liability,
the pass-through entity will be liable for the tax liability and all applicable interest and penalties.
PART II: DECLARATION OF OFFICER
Under the penalties of perjury, I declare that I am an officer of the above pass-through entity and that the information I have given my electronic return originator (ERO),
transmitter, and/or intermediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding lines of the pass-through entity's
Mississippi Pass-Through Entity Tax Return. To the best of my knowledge and belief, the pass-through entity's return is true, correct and complete. I consent to my ERO,
transmitter, and/or ISP sending the pass-through entity's return, this declaration, and accompanying schedules and statements to the Department of Revenue (DOR). I also
consent to the DOR my ERO, transmitter, and/or ISP an acknowledgement of receipt of transmission and an indication of whether or not the pass-through entity's return is
accepted, and, if rejected, the reason(s) for the rejection. This declaration is to be maintained by the ERO and provided to DOR on request.

Sign
Here

Signature of Officer

Date

Title

PART lll: DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER
I declare that I have reviewed the above pass-through entity's return and that the entries on Form MS8453-PTE are complete and correct to the best of my knowledge. If I am
only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The corporate officer will have signed
this form before I submit the return. I will give the officer a copy of all forms and information to be filed with the Department of Revenue (DOR), and have followed all other
requirements in Pub. 3112, IRS e-file Application and Participation and Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers. If I am also the
Paid Preparer, under penalties of perjury, I declare that I have examined the above pass-through entity's return and accompanying schedules and statements, and to the best
of my knowledge and belief, they are true, correct and complete. This Paid Preparer declaration is based on all information of which I have any knowledge.

ERO
Use
Only

ERO Signature

Date

Check if Also
Paid Preparer

Check if SelfEmployed

ERO SSN or PTIN

EIN

Firm Name (or yours if
self-employed), address
and ZIP code

Phone No.

Under penalties of perjury, I declare that I have examined the above pass-through entity's return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

Paid
Preparer
Use Only

Preparer Signature

Firm Name (or yours if
self-employed), address
and ZIP code

Date

Check if Also
Paid Preparer

Check if SelfEmployed
EIN

Phone No.

DO NOT Mail this Document to the Mississippi Department of Revenue

Preparer SSN or PTIN