Form Mo-Ptc - Property Tax Credit Claim - 1999 printable pdf download

Enclosure Sequence No. 1040-07

1999

DLN

MISSOURI DEPARTMENT OF REVENUE

FORM

PROPERTY TAX CREDIT CLAIM

MO-PTC

QUALIFICATIONS — (CHECK ONLY ONE)

You or your spouse must be 65 years of age or older as of December 31,

You or your spouse must be disabled as defined in Section 135.010(2),

RSMo. YOU MUST ENCLOSE A COPY OF A LETTER FROM SOCIAL

1999; and you or your spouse must have been a Missouri resident for the

SECURITY ADMINISTRATION, FORM SSA-1099 OR YOUR MEDICARE

entire 1999 calendar year. IF YOU ARE 65 OR OLDER, YOU MAY QUALI-

CARD.

FY FOR A PHARMACEUTICAL TAX CREDIT. IF FILING FORM MO-1040,

You must be 60 years of age or older as of December 31, 1999 and

FIGURE CREDIT ON FORM MO-1040, OTHERWISE SEE LINE 16.

received surviving spouse social security benefits during 1999. YOU

You or your spouse must be a veteran of any branch of the armed forces

MUST ENCLOSE A COPY OF FORM SSA-1099.

of the United States or this state who became 100% disabled as a result of

such service. YOU MUST ENCLOSE A COPY OF THE LETTER FROM

DECEASED SPOUSE’S NAME

DATE OF DEATH

DEPARTMENT OF VETERANS AFFAIRS.

STEP 1 — NAME, ADDRESS, SOCIAL SECURITY NUMBER(S) AND BIRTHDATE(S)

YOUR LAST NAME

FIRST NAME

INITIAL

BIRTHDATE

YOUR SOCIAL SECURITY NO.

SCHOOL

DISTRICT NO.

(SEE INSTRUCTIONS)

PLACE LABEL IN BLOCK

SPOUSE’S LAST NAME

FIRST NAME

INITIAL

BIRTHDATE

SPOUSE’S SOCIAL SECURITY NO.

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

TELEPHONE NUMBER

(

)

–

PRESENT HOME ADDRESS

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

AMENDED

RETURN

STEP 2 — FILING STATUS (CHECK ONLY ONE)

1. Single

2. Married — Filing Combined (see instructions)

3. Married — Living Separate for Entire Year

4. Did you file Form MO-PTC in 1982 and claim credit for the same homestead you occupied and paid real estate tax for in 1999? If you rent, check “No”.

Yes

SECTION A: STEP 3 — REPORT YOUR HOUSEHOLD INCOME

Items Must Be

SECTION A: Complete only Section A, if you did not file a Form MO-1040 and your only sources of income are

Included With

from social security, pensions and annuities, dividends, interest income or public assistance.

Return

Otherwise, please complete Section A, Page 1 and Section B, Page 2.

YOURSELF

SPOUSE

5. Social security benefits before any deductions

Form SSA-1099

(enclose Form SSA-1099)

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

6. Pensions and annuities, dividends or interest income (if filing Form MO-1040, enter amount not

Form 1099-R

included on Form MO-1040) (enclose Form 1099-R) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Enter total public relief, public assistance, SSI, AFDC payments and unemployment benefits . . . . . . .

Form SSA-1099

or Letter from

8. Total from Section B, Line H — if you have income not listed on Lines 5 through 7, complete

SSA, if applicable

Section B on reverse side and enter amount from Section B, Line H here. . . . . . . . . . . . . . . . . . . . .

9. TOTAL household income — add Lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. If Filing Status, Box 2 (MARRIED — FILING COMBINED), is checked, enter $2,000 . . . . . . . . . . .

11. Net household income — (Subtract Line 10 from Line 9.) If the total on Line 11 is over $25,000

No credit is allowed — Do not file this claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SECTION A: STEP 4 — REPORT YOUR PROPERTY TAX OR RENT PAID

12. Homestead owned (Enter amount of city and county real estate tax

Real Estate

that you paid for your homestead, Part 1, Line 5.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tax Receipt

12a. Homestead school tax (Enter amount from

Form 948

(if more

your tax receipts, Part 1, Line 5a.) . . . . . . . . . . . . . . . . . . .

than five acres)

13. Homestead rented — enter amount from Form MO-CRP, Line 7.

Form MO-CRP,

(If Line 13 is more than Line 11, enclose payment explanation.)

x 20%

Rent Receipts

14. Total amount from Lines 12 and 13 (do not add 12a) or $750, whichever is less . . . . . . . . . . . . . . .

SECTION A: STEP 5 — FIGURE YOUR PROPERTY TAX AND/OR PHARMACEUTICAL TAX CREDIT

15. PROPERTY TAX CREDIT (apply Lines 11 and 14 to 1999 Table for Determining Amount of Property Tax Credit or Refund) . . . .

16. PHARMACEUTICAL TAX CREDIT (If required to file Form MO-1040, enter “0” here;

YOURSELF

YOUR SPOUSE

figure your credit on Form MO-1040.) If not filing Form MO-1040, enter $200

for each claimant 65 years of age or older. MUST BE AGE 65 OR OLDER . . . . . .

17. TOTAL CREDIT OR REFUND (add Lines 15 and 16; if filing Form MO-1040, enter Line 15 amount here and on Form MO-1040, Line 36.) . . . .

Under penalties of perjury, I declare that I have examined this claim, 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 has any knowledge. As provided in Chapter 143 RSMo, a penalty of up to $500.00 shall be imposed on any individual who files a frivolous return.

I authorize the Director of Revenue or delegate to discuss my return

PREPARER’S TELEPHONE

and attachments with the preparer or any member of his/her firm.

YES

YOUR SIGNATURE

DATE

PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)

FEIN, SSN OR PTIN

DOR

ONLY

SPOUSE’S SIGNATURE (IF FILING COMBINED, BOTH MUST SIGN EVEN IF ONLY ONE HAD INCOME)

PREPARER’S ADDRESS (AND ZIP CODE)