2014 M1pr Mn Property Tax Refund Questionnaire printable pdf download

2014 M1pr Mn Property Tax Refund Questionnaire

2014 M1PR MN Property Tax Refund Questionnaire

**Please include your 2015 Property Tax Statement or 2014 CRP Form**

Did you own & live in your home on January 2, 2014 & January 2, 2015? Y / N

Did you rent out or use part of your home for business? Y / N

Report the following income if any in 2014. Attach statements if applicable:

$ ____________

Welfare received, including MFIP (MN Family Investment Program), MSA (MN

Supplemental Aid), SSI (Supplemental Security Income), GA (General Assistance),

GRH (Group Residential Housing) – DOES NOT INCLUDE MED ASSISTANCE

$ ____________

Workers compensation

$ ____________

Nontaxable forgiveness of debt income

$ ____________

Nontaxable employee transit & parking expenses

$ ____________

Veterans benefits

$ ____________

Nontaxable scholarships, fellowships or grants

$ ____________

Nontaxable disability payments

$ ____________

Reduction in rent for caretaking responsibilities

$ ____________

Housing allowance for military or clergy

$ ____________

Nontaxable military income

$ ____________

Strike benefits

$ ____________

Employer paid education or adoption benefits

$ ____________

Gain on the sale of your home excluded from federal income

$ ____________

Homeowners only: Income of persons other than spouse or dependents for the period

of time they lived with you in 2014.

I wish to donate $__________ of my refund to the MN Nongame Wildlife Fund.

_____ I would like my refund directly deposited using the same information from my tax return.

_____ I would like my refund mailed to me in the form of a check.

I certify that the above the information is correct and complete and that I own and occupy the property as my

principal place of residence. I authorize Bertolas & Pekula, LLC to prepare the MN Property Tax Refund Return

for 2014 and agree to pay a processing fee of $35.

Print: ______________________________ Signature: ______________________ Date: _____________

Phone Number: ____________________________

Date paid $35 fee _________________ Paid by Check # _________ or Credit Card (circle one)

2014 M1pr Mn Property Tax Refund Questionnaire

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