Form 200A – Mississippi Motion Picture Incentive Non-Resident Payroll Rebate Pre-Approval Application

Form 200A - Non-Resident Payroll Rebate Pre-Approval Application

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About Your Project

Use information from Form 100A
I am requesting pre-approval to receive a 25% rebate on payroll paid to non-resident employees for work completed in Mississippi for the project listed above.(Required)
Is the applicant production company based in Mississippi?(Required)
Has this company been associated with the production of at least 2 nationally distributed motion pictures in Mississippi within the last 10 years?(Required)
If yes, please provide a signed and notarized MDOR Taxpayer Form.
If yes, please provide the following production information for verification:
Production Title
Type of Project
Year Produced
 
Is the a subsidiary company of the applicant production company based in Mississippi?(Required)
If yes, please provide a signed and notarized MDOR Taxpayer Form. Additional information regarding company structure and/or ownership may be required.
Has this subsidiary company been associated with the production of at least 2 nationally distributed motion pictures in Mississippi within the last 10 years?(Required)
If yes, please provide the following production information for verification:
Production Title
Type of Project
Year Produced
 
Is an owner/principal/member of the applicant production company a resident of Mississippi?(Required)
If yes, please provide a signed and notarized MDOR Taxpayer Form. Additional information regarding company structure and/or ownership may be required.
Has this individual been associated with the production of at least 2 nationally distributed motion pictures in Mississippi within the last 10 years?(Required)
If yes, please provide the following production information for verification:
Production Title
Type of Project
Year Produced
 
Will a Mississippi resident or Mississippi-based company be serving as a production partner for the applicant production company’s project?(Required)
A production partner is defined as a director, producer, production supervisor/manager, director of photography, production designer, casting director, production company, production services company or post production services company.
Drop files here or
Accepted file types: pdf, docx, txt, Max. file size: 10 MB, Max. files: 2.
    Has the Mississippi resident or Mississippi-based company been pre-qualified by MDA as a production partner?

    If no, production partner must:

    • Complete Form 300A AND
    • Provide signed and notarized MDOR Taxpayer Form

    Signature

    Type your name to sign.
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