The State Tax Commission shall print on the Mississippi income tax form for residents a space for designating the contribution in substantially the following form:
"MISSISSIPPIBURN CARE FUND
I wish to contribute ( )$1 ( )$5 ( )$10 ( )Other $ _______________of my TAX REFUND TO THE MISSISSIPPI BURN CARE FUND."
The State Tax Commission shall print on the Mississippi income tax form for residents a space for indicating the amount of the contribution in substantially the following form:
"MISSISSIPPIBURN CAREFUND
I wish to contribute ( )$1 ( )$5 ( )$10 ( )Other $ _______________to the MISSISSIPPI BURN CARE FUND, in addition to the payment of my income tax liability or in addition to the amount of my tax refund that I designated as a contribution to the fund."