Form Mi-1040cr-7 - Home Heating Credit Claim - 2003
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2003 MICHIGAN
2003
Home Heating Credit Claim
MI-1040CR-7
Issued under authority of P.A. 281 of 1967.
Type or print in blue or black ink.
Attachment Sequence No. 08
4
Filer's Social Security Number
2.
4
Filer's First Name and Middle Initial and Last Name
1.
4
If a Joint Return, Spouse's First Name and Middle Initial and Last Name
Spouse's Social Security Number
3.
Home Address (No., Street, P.O. Box or Rural Route)
City or Town
State
ZIP Code
Are your heating costs currently included in your rent
4
Enter the number that
4
4.
11.
Exemptions.
or is your heat service in someone else's name? If
applies to you, your spouse or your
you check YES, you will receive a check (see line 36).
YES
NO
dependents and complete line 12 below.
If you check NO or leave blank, you will receive an
Personal Exemption (1 or 2)
4
A.
ENERGY DRAFT.
Age 65 or older
4
B.
4
Do you want your name and address referred to other
Deaf, Disabled or Blind
5.
4
C.
government assistance programs you may qualify for?
YES
NO
Unemployment compensation
If you live in one of these CARE facilities, check the box.
greater than 50% of AGI (Enter 1)
4
4
6.
D.
Number of children living with you:
Nursing Home
Adult Foster Care Home
A.
B.
Ages 2 and under
C.
Licensed Home for the Aged
D.
Substance Abuse Center
4
E.
Ages 3 - 5
4
Do you or your spouse now receive
4
7.
F.
Ages 6 - 18
Supplemental Security Income (SSI)?
YES
NO
4
G.
Dependent adults, other than
AGE. If you are age 60 or older,
4
8.
your spouse, who live with you
enter your age.
You
Spouse
A.
B.
(including children over 18)
4
How much were you billed for heat
County Code
4
4
H.
9.
10.
Add lines A through H
.00
between 11/1/2002 - 10/31/2003?
$
I.
12. Enter below the name, Social Security number, relationship and age of the dependents you claimed (see line 11, E - H above).
Social Security Number
Age in Years
Dependent's Name
Dependent's Relationship to You
a.
b.
c.
d.
Be sure to include income from both spouses.
.00
13.
Wages, salaries, tips, sick, strike and SUB pay, etc
13.
.00
14.
All interest and dividend income (including nontaxable interest)
14.
.00
Net rent, business or royalty income
4
15.
15.
.00
16.
Annuity, pension and IRA benefits. Name of Payer:
16.
.00
17.
Net farm income
17.
.00
18.
Capital gains less capital losses
18.
.00
19.
Alimony and other taxable income
Describe:
19.
(see instructions).
.00
Social Security, Supplemental Security Income (SSI) and/or railroad retirement benefits
4
20.
20.
.00
21.
Child support
21.
.00
Unemployment compensation
4
22.
22.
.00
23.
Other nontaxable income
. Describe:
23.
(see instructions)
.00
24.
Workers' compensation, veterans' disability compensation and pension benefits
24.
.00
FIP and other FIA benefits
4
25.
25.
.00
26.
Subtotal. Add lines 13 - 25
26.
Subtotal
27.
.00
27.
Other adjustments
. Describe:
(see instructions)
28.
.00
28.
Medical insurance or HMO premiums you paid for you and your family
.00
29.
Add lines 27 and 28
29.
.00
HOUSEHOLD INCOME. Subtract line 29 from line 26 (If a negative amount, enter "0".)
4
30.
30.
Go to page 2 and complete lines 33-41 (Standard and Alternate Home Heating Credit Computations).
.00
31.
Enter the amount from line 41
31.
.00
HOME HEATING CREDIT. Multiply the amount on line 31 by 80% (0.80)
4
32.
32.
Claim must be filed (postmarked) by September 30, 2004 to receive a credit.
Continued on page 2.
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