Form 948 - Assessor Certification - 2014

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Missouri Department of Revenue
Form
948
Assessor Certification
Attach this form to the Property Tax Credit Claim
(Form
MO-PTC), Property Tax Credit
(Form
MO-PTS), or the Public Safety Officer
Surviving Spouse Credit
(Form
MO-SSC).
Last Name
First Name
Middle Initial
Social Security Number
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Spouse’s Last Name
First Name
Middle Initial
Social Security Number
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Address
City
State
Zip Code
E-mail Address
Claimant
If your real estate tax receipt on your homestead includes tax on your dwelling and surrounding
Tax Year
land which exceeds five (5) acres, the county assessor must complete this section to determine the
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appropriate percentage you may claim on
Form
MO-PTC,
Form
MO-PTS, or
Form
MO-SSC.
Assessor
1
1. Enter assessed valuation of dwelling.............................................................
2. Enter assessed valuation of surrounding land up to
2
five (5) acres used for homestead purposes .................................................
3
3. Total valuation of homestead (Add Lines 1 and 2) ................................................................................
4
4. Enter total assessed valuation on the single tax receipt or single assessment on a tax receipt ...........
5. Compute percentage of tax allocated to the homestead (Divide Line 3 by Line 4)
%
5
(Round to a whole percent.) ..................................................................................................................
6. Multiply the Total Tax Paid by the percentage on Line 5. Enter the amount here and on
6
Form
MO-PTC, Line 9;
Form
MO-PTS, Line 11; or
Form MO-SSC
....................................................
Claimant
If you own a mobile home and the tax is shown on your personal property tax receipt, the county assessor must complete this
section to determine the appropriate percentage you may claim on
Form
MO-PTC,
Form
MO-PTS, or
Form
MO-SSC.
Assessor
1
1. Valuation of mobile home only...............................................................................................................
2
2. Total valuation of all personal property ..................................................................................................
3. Compute percentage of personal property tax allocated to the mobile home
%
3
(Divide Line 1 by Line 2) (Round to a whole percent.)..........................................................................
4. Multiply the Total Tax Paid by the percentage on Line 3. Enter the amount here and on
Form
4
MO-PTC,Line 9;
Form
MO-PTS, Line 11; or
Form MO- SSC
.............................................................
Assessor’s Name
Telephone Number
(__ __ __) __ __ __ - __ __ __ __
Assessor’s Signature
Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Form 948 (Revised 12-2014)
Mail to:
Taxation Division
Phone: (573) 751-3505
Visit
P.O Box 2200
Fax: (573) 751-2195
for additional information.
Jefferson City, MO 65105-2200
E-mail:
income@dor.mo.gov

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