Form 100A – Mississippi Motion Picture Incentive Application

Application Phase(Required)

New application

Revision to previously submitted application

Project Title(Required)

Type of Production(Required)

Main Contact

Name(Required)

First Last

Job Title(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other Contact Information

Name of Line Producer and/or Production Manager:

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Production Accountant

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Director(Required)

Names of Leading Cast Members(Required)

Email address for receiving crew/cast resumes:(Required)

Proposed Dates of Work

Start date for pre-production(Required)

Number pre-production days(Required)

Start date for principal photography(Required)

Number principal photography days(Required)

Wrap date for principal photography(Required)

Wrap date for post-production (if in Mississippi)

Number post-production days

City where production will be based in Mississippi(Required)

Other sites outside Mississippi being considered(Required)

Intended Plan for Distribution

Check all that apply(Required)

Theatrical

Film Festival

Direct to Video/DVD

Streaming Video/Internet Delivery

Television/Cable Broadcast

Television / Cable network, if known

Budget

Total Budget(Required)

Funded?(Required)

Yes

Total # of crew hires:(Required)

Anticipated # of MS crew hires:(Required)

Estimate your Mississippi expenditures

Enter numbers in the fields below. The form will calculate your estimated rebate. Please note that all numbers provided are estimates, subject to review & availability.

[a] Mississippi local spend (non-payroll) ($)

25% rebate

[b] Mississippi non-resident payroll ($)

25% rebate

[c] Mississippi resident payroll

30% rebate

[d] Mississippi resident, veteran payroll

35% rebate

Total Mississippi Budget Estimate ([a] + [b] + [c] + [d] + [e]):

Estimated Rebate:

The following must be submitted to complete application:

1. A one paragraph summary of your project:(Required)

2. Copy of script (feature/TV), or a storyboard (commercial), or documentary outline/treatment.(Required)

Max. file size: 256 MB.

3. Full budget with top sheet.(Required)

Max. file size: 256 MB.

Eligibility for Non-Resident Payroll Rebate through applicant's company

Will you be requesting the 25% rebate for the production's non-resident payroll?(Required)

Yes

I attest this project does not include any material or performance defined in Section 97-29-103 of the Mississippi State Code*.(Required)

Yes

*http://mscode.com/free/statutes/97/029/0130.htm

I attest this production company does not include any company owned, affiliated, or controlled, in whole or in part, by any company or person which is in default on a loan made by the state or a loan guaranteed by the state, or any company or person who has ever declared bankruptcy under which an obligation of the company or person to pay or repay public funds or monies was discharged as a part of such bankruptcy.(Required)

Yes

Your Name(Required)

Project Title(Required)

Signature(Required)

Type your name to sign

Date

Please be advised that making false representations and/or submitting falsified documents to either the Mississippi Development Authority or the Mississippi Department of Revenue with an intent to defraud the state is a crime and may lead to both civil and criminal penalties. Miss. Code Ann. § 97-7-10 states, “Whoever, with intent to defraud the state or any department, agency, office, board, commission, county, municipality or other subdivision of state or local government, knowingly and willfully falsifies, conceals or covers up by trick, scheme or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall, upon conviction, be punished by a fine of not more than Ten Thousand Dollars ($10,000.00) or by imprisonment for not more than five (5) years, or by both such fine and imprisonment.”

Name

This field is for validation purposes and should be left unchanged.

Form 100A – Mississippi Motion Picture Incentive Application

Mississippi Motion Picture Incentive Application

Main Contact

Company Information

Other Contact Information

Proposed Dates of Work

Intended Plan for Distribution

Budget

Estimate your Mississippi expenditures

The following must be submitted to complete application:

Eligibility for Non-Resident Payroll Rebate through applicant's company