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Missouri Department of Revenue
(MM/DD/YY)
Form
2016 Miscellaneous Income Tax Credits
MO-TC
Attachment Sequence No. 1040-02 or 1120-03
Social Security
Name
(Last, First)
Number
Spouse’s Name
Spouse’s Social
(Last, First)
Security Number
Corporation
Charter
Name
Number
Missouri Tax
Federal Employer
I.D. Number
I.D. Number
• E ach credit will apply against your tax liability in the order they appear on the form.
• I f you are claiming more than 10 credits, attach additional MO-TC(s).
• If you are claiming a tax credit for both taxpayers on a combined return, both names must be on the certificate.
• I f you are a shareholder or partner and claiming a credit, you must attach a copy of the shareholder listing, specifying your percentage of ownership,
including the corporation’s percentage of ownership, if applicable
• Yourself (one income)
• Spouse
Alpha Code
• Corporation Income
(on a combined return)
Credit Name
Benefit Number
(3 characters)
• Fiduciary
Each credit will apply in the order they appear below
from back
Column 1
Column 2
1.
1.
00
00
2.
2.
00
00
3.
3.
00
00
4.
4.
00
00
5.
5.
00
00
6.
6.
00
00
7.
7.
00
00
8.
8.
00
00
9.
9.
00
00
1 0.
10.
00
00
11.
11.
00
00
Subtotals - add Lines 1 through 10
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12.
Enter the amount of the tax liability from Form MO-1040, Line 32Y for yourself and
Line 32S for your spouse, or from Form MO-1120, Line 14 plus Line 15 for income
12.
00
00
or Form MO-1041, Line 18.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13.
Total Credits - add amounts from Line 11, Columns 1 and 2. (Enter here and on Form MO-1120, Line 17; Form MO-1040, Line 39;
or Form MO-1041, Line 19.) Line 13 cannot exceed the amount on Line 12, unless the credit is refundable. . . . . . . . . . . . . . . . . . . . . .
13.
00
• I f you are filing an individual income tax return and you have only one income, use Column 1.
• I f you are filing a combined return and both you and your spouse have income, use Column 1 for yourself and Column 2 for your spouse.
• If you are filing a fiduciary return, use Column 1.
• If you are filing a corporation income tax return, use Column 1.
• Include a copy of your certificate or form from the issuing agency.
Benefit Number - The number is located on your Certificate of Eligibility Schedule (Certificate).
Alpha Code - This is the three character code located on the back of the form. Each credit is assigned an alpha code to ensure proper processing of the credit claimed.
I declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax
exemption, credit or abatement if I employ such aliens. I also declare that if I am a business entity, I participate in a federal work authorization program
with respect to the employees working in connection with any contracted services and I do not knowingly employ any person who is an unauthorized alien
in connection with any contracted services.
*16306010001*
Use this form to claim income tax credits on Form MO-1040, MO-1120,
16306010001
or MO-1041. Attach to Form MO-1040, MO-1120, or MO-1041.
Form MO-TC (Revised 12-2016)