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Missouri Department of Revenue
Form
MO-CRP
2016 Certification of Rent Paid
One Form MO-CRP must be provided for each rental location in which you resided.
Failure to provide landlord information will result in denial or delay of your claim.
1. Social Security
Spouse’s
Number (SSN)
SSN
If yes,
Are you related to your landlord?
Yes
No
explain
2. Name
Physical Address of Rental
Apartment
Unit (P.O. Box Not Allowed)
Number
City
State
ZIP Code
3. Landlord’s Name
Landlord’s Last 4 Digits of
Landlord’s Federal Employee
Social Security Number
or
Identification Number (FEIN)
Landlord’s Street Address
Apartment
(Must be completed)
Number
City
State
ZIP Code
4. Landlord’s Phone Number (Must be completed)
From:
To:
5. Rental Period During Year
(MM/DD/YY)
(MM/DD/YY)
6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement from your
landlord, or copies of canceled checks (front and back). If you received housing assistance, enter the amount of rent you
6.
.
00
paid. Note: If you rent from a facility that does not pay property tax, you are not eligible for a Property Tax Credit. . . . . . . . . .
7.
%
7. Select the appropriate box below and enter the corresponding percentage on Line 7. . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Apartment, House, Mobile Home, or Duplex - 100%
B. Mobile Home Lot - 100%
C. Boarding Home or Residential Care - 50%
D. Skilled or Intermediate Care Nursing Home - 45%
E. Hotel, if meals are included, enter - 50%; Otherwise, enter - 100%
F. Low Income Housing - 100% (Rent cannot exceed 40% of total household income.)
G. Shared Residence – If you shared your rent with relatives or friends (other than your spouse or children
under 18), select the appropriate box based on the additional persons sharing rent:
1 (50%)
2 (33%)
3 (25%)
8.
.
00
8. Net rent paid - Multiply Line 6 by the percentage on Line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
.
00
9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS. . . . . . . . . .
For Privacy Notice, see instructions.
Form MO-CRP (Revised 12-2016)
*16315010001*
Taxation Division
16315010001
Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.