Mississippi Motion Picture Incentive Application

Film

The following must be submitted to complete application:
  • Copy of script & synopsis, or a commercial story board, or documentary outline/treatment
  • Full budget with top sheet
  • Signed application form
New application
Revision to previously approved application
Project Title:
Type of Production (Pick one)
Feature
Music Video
Internet Broadcast
Television Episode or Series
Video Game
Documentary
Reality Show
National Commercial
Animation
Game Show
National Infomercial
Visual Effects
Short Film
Webisodes
Interstitials
Interactive Media
Main Contact
Name:
Title:
Phone:
Email:
Address:
Company to Receive Rebate and Tax Reductions (The company that will be receiving invoices.) NOTE: Federal Tax ID must match to recieve rebate.
Company Name:
Street Address:
Phone:
Email:
Website:
Other Contact Information
Name of Line Producer and/or Production Manager:
Phone:
Address:
Email:
Name of Production Accountant:
Phone:
Address:
Email:
Proposed Dates of Work
Start date for pre-production:
Start date for principal photography:
Wrap date for principal photography:
Wrap date for post-production (if in MS):
Budget
Total Budget:
 
Funded? Yes No
Estimate your MS expenditures:
a) MS local spend (non-payroll), 25% rebate:
x .25 = d)
b) MS non-resident payroll, 25% rebate:
x .25 = e)
c) MS resident payroll, 30% rebate:
x .30 = f )
Total MS Budget Estimate:
Anticipated rebate:
Note: (a) + (b) + (c) = Total MS Budget
Note: (d) + (e) + (f ) = Anticipated Rebate
Intended Plan for Distribution (check all that apply)
Theatrical
Direct to Video/DVD
Television/Cable Broadcast
Streaming Video/Internet Delivery
Film Festival
Other sites outside Mississippi being considered
I attest this project does not include any material or performance defined in Section 97-29-103 of the Mississippi State Code. 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.
Name (Printed):
Title for Production:
Signature:
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.”

MISSISSIPPI FILM OFFICE
Woolfolk State Office Building
501 North West Street, 5th Floor
Jackson, MS 39201
P.O. Box 849
Jackson, MS 39205
T: 601-359-3297
F: 601-359-5048
Nina Parikh
nparikh@mississippi.org
Thabi Moyo
tmoyo@mississippi.org
Betty Black
bblack@mississippi.org
Meg Lake
mlake@mississippi.org
Bill Webb (Gulf Coast Office)
bwebb@mississippi.org