Form Mo-Ptc - Property Tax Credit Claim - 2012 printable pdf download

2012

MISSOURI DEPARTMENT OF REVENUE

FORM

PROPERTY TAX CREDIT CLAIM

MO-PTC

LAST NAME

FIRST NAME

INITIAL BIRTHDATE (MMDDYYYY)

SOCIAL SECURITY NO.

DECEASED

SOFTWARE

2012

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VENDOR CODE

PLACE LABEL IN BLOCK

(Assigned by DOR)

SPOUSE’S LAST NAME

FIRST NAME

INITIAL BIRTHDATE (MMDDYYYY)

SPOUSE’S SOCIAL SECURITY NO.

DECEASED

002

2012

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IN CARE OF NAME (ATTORNEY, EXECUTOR, PERSONAL REPRESENTATIVE, ETC.)

TELEPHONE NUMBER

AMENDED

(__ __ __) __ __ __ – __ __ __ __

CLAIM

PRESENT HOME ADDRESS

APT. NUMBER CITY, TOWN, OR POST OFFICE, STATE, AND ZIP CODE

You must check a qualification to be eligible for a credit. Check only one. REQUIRED COPIES OF LETTERS, FORMS, ETC., MUST BE INCLUDED WITH CLAIM.

C. 100% Disabled (ATTACH A COPY OF THE LETTER FROM

A. 65 years of age or older (ATTACH A COPY OF FORM SSA‑1099.)

SOCIAL SECURITY ADMINISTRATION OR FORM SSA‑1099.)

B. 100% Disabled Veteran as a result of military service (ATTACH A COPY

D. 60 years of age or older and received surviving spouse

OF THE LETTER FROM DEPARTMENT OF VETERANS AFFAIRS.)

benefits (ATTACH A COPY OF FORM SSA‑1099.)

If married filing combined,

Married — Living Separate for Entire Year

Single

Married — Filing Combined

FILING STATUS

you must report both incomes.

FAILURE TO PROVIDE THE ATTACHMENTS LISTED BELOW (RENT RECEIPT(S), TAX RECEIPT(S), FORMS 1099, W-2, ETC.) WILL RESULT IN DENIAL OR DELAY OF YOUR CLAIM!

1. Enter the amount of social security benefits received by you, your spouse, and your minor children before any deductions

and the amount of social security equivalent railroad retirement benefits.

ATTACH FORMS SSA‑1099 and RRB‑1099.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Enter the total amount of wages, pensions, annuities, dividends, interest income, rental income, or other income.

ATTACH FORMS W‑2, 1099, 1099‑R, 1099‑DIV, 1099‑INT, 1099‑MISC, ETC.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Enter the amount of railroad retirement benefits (not included in Line 1) before any deductions.

ATTACH FORM RRB‑1099‑R (TIER II).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Enter the amount of veteran’s payments or benefits before any deductions. ATTACH LETTER FROM VETERANS AFFAIRS.

. . .

5. Enter the total amount received by you, your spouse, and your minor children from: public assistance, SSI, child support,

Temporary Assistance payments (TA and TANF). ATTACH COPY OF FORMS SSA‑1099, A LETTER FROM THE

SOCIAL SECURITY ADMINISTRATION AND SOCIAL SERVICES THAT INCLUDES THE TOTAL AMOUNT OF

ASSISTANCE RECEIVED AND EMPLOYMENT SECURITY 1099, IF APPLICABLE.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. TOTAL household income — Add Lines 1 through 5.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Mark the box that applies and enter the appropriate amount.

a. Enter $0 if filing status is Single or Married Living Separate;

If married and filing combined;

b. Enter $2,000 if you rented or did not own your home for the entire year;

c. Enter $4,000 if you owned and occupied your home for the entire year;

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Net household income — Subtract Line 7 from Line 6; and enter the amount; mark the box that applies.

a. If you rented or did not own and occupy your home for the entire year, Line 8 cannot exceed $27,500.

If the total is greater than $27,500, STOP ‑ no credit is allowed. Do not file this claim.

b. If you owned and occupied your home for the entire year, Line 8 cannot exceed $30,000.

If the total is greater than $30,000, STOP ‑ no credit is allowed. Do not file this claim.

. . . . . . . . . . . . . . . . . . . . . . .

9. If you owned your home, enter the total amount of property tax paid for your home, less special assessments,

or $1,100, whichever is less. ATTACH A COPY OF PAID REAL ESTATE TAX RECEIPT(S). IF YOUR HOME IS ON

MORE THAN FIVE ACRES OR YOU OWN A MOBILE HOME, ATTACH FORM 948, ASSESSOR’S CERTIFICATION.

. . .

10. If you rented, enter the total amount from Form(s) MO-CRP, Line 9, or $750, whichever is less. Attach rent receipts or a

signed statement from your landlord. NOTE: If you rent from a facility that does not pay property tax, you are not

eligible for a Property Tax Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. Enter the total of Lines 9 and 10, or $1,100, whichever is less. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. You must use the chart on pages 13‑15 to see how much refund you are allowed.

Apply amounts from Lines 8 and 11 to chart on pages 13-15 to figure your Property Tax Credit.

Debit Card 12

Check the box if you want your refund issued on a debit card. See instructions for Line 12.

. . . . . . . . . . . . . . .

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, and complete. Declaration of

preparer (other than taxpayer) is based on all information of which he or she has any knowledge. As provided in Chapter 143, RSMo, a penalty of up to $500 shall be imposed on any individual who files a frivolous

return. I also 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 authorize the Director of Revenue or delegate to discuss my claim and attachments

E-MAIL ADDRESS

PREPARER’S PHONE

(__ __ __) __ __ __ - __ __ __ __

with the preparer or any member of the preparer’s firm.

YES

SIGNATURE

DATE (MMDDYYYY)

PREPARER’S SIGNATURE

FEIN, SSN, OR PTIN

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SPOUSE’S SIGNATURE (If filing combined, BOTH must sign)