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Form 200A – Mississippi Motion Picture Incentive Non-Resident Payroll Rebate Pre-Approval Application
Form 200A – Non-Resident Payroll Rebate Pre-Approval Application
Date
MM slash DD slash YYYY
About Your Project
Use information from Form 100A
Project Title
(Required)
Company Name
(Required)
Main Contact Person
(Required)
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)
Yes
No
Is the applicant production company based in Mississippi?
(Required)
Yes
No
Has this company been associated with the production of at least 2 nationally distributed motion pictures in Mississippi within the last 10 years?
(Required)
Yes
No
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
Add
Remove
Is the a subsidiary company of the applicant production company based in Mississippi?
(Required)
Yes
No
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)
Yes
No
If yes, please provide the following production information for verification:
Production Title
Type of Project
Year Produced
Add
Remove
Is an owner/principal/member of the applicant production company a resident of Mississippi?
(Required)
Yes
No
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)
Yes
No
If yes, please provide the following production information for verification:
Production Title
Type of Project
Year Produced
Add
Remove
Will a Mississippi resident or Mississippi-based company be serving as a production partner for the applicant production company’s project?
(Required)
Yes
No
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.
If yes, please provide the name of the individual or company serving as production partner:
Please provide documentation (contract, deal memo, or other legal document between the 2 entities) outlining duties to be performed or that describe the working relationship
(Required)
Drop files here or
Select files
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?
Yes
No
If no, production partner must:
Complete Form 300A AND
Provide signed and notarized MDOR Taxpayer Form
Signature
Your Name
(Required)
Project Title
(Required)
Your Signature
(Required)
Type your name to sign.
Date
MM slash DD slash YYYY
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