Fillable Form Mo-Ptc - Property Tax Credit Claim

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DO NOT file this claim if you are going to file a Missouri income tax return! See the instructions.

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AMENDED CLAIM

2016 FORM MO-PTC

MISSOURI DEPARTMENT OF REVENUE

VENDOR

(NOTE: For proper form functionality, utilize Internet Explorer

006

CODE

PROPERTY TAX CREDIT CLAIM

006

browser and Adobe Reader for PDF viewer.)

SOCIAL SECURITY NO.

SPOUSE’S SOCIAL SECURITY NO.

INSTRUCTIONS:

- You must use the print button at the top of page to print form

JR, SR

- Don't forget to attach all required forms

LAST NAME

FIRST NAME

INITIAL

- You can tab from one field to another or use the mouse to

click in the field you want.

BIRTHDATE (MMDDYY)

TELEPHONE NUMBER

DECEASED

__ __/__ __/__ __

2016

(_ _ _)_ _ _-_ _ _ _

- You must use your mouse to click in the check boxes.

- If a field does not allow a negative number, and a negative

JR, SR

SPOUSE’S LAST NAME

FIRST NAME

INITIAL

number is entered, a zero will be displayed.

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

BIRTHDATE (MMDDYY)

DECEASED

__ __/__ __/__ __

2016

PRESENT ADDRESS (INCLUDE APARTMENT NO. OR RURAL ROUTE)

CITY, TOWN, OR POST OFFICE

STATE

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.

A. 65 years of age or older

C. 100% Disabled (Attach a copy of the letter from Social

(Attach a copy of Form SSA-1099. You must be a full year resident.)

Security Administration or Form SSA-1099.)

B. 100% Disabled Veteran as a result of military service

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

(Attach a copy of the letter from Department of Veterans Affairs.)

(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

Line 1

amount of social security equivalent railroad retirement benefits. ATTACH Forms SSA-1099, RRB-1099, or SSI Statement. . . . . . . . . . . . .

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

Line 2

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). .

Line 3

4. Enter the amount of veteran’s payments or benefits before any deductions. ATTACH letter from Veterans Affairs. . . . . . . . . . . . . . .

Line 4

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

Line 5

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 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; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Line 7

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

Line 8

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

Line 9

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

Go To Form MO-CRP

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

Line 10

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

Line 11

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Line 12

If you would like your refund deposited directly to your checking or savings account, complete boxes a, b, and c below.

a. Routing Number

b. Account Number

Checking

Savings

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