Form Mo-1040 And Mo-A Instructions - Missouri Department Of Revenue

use authorization form, which is required to

Workers’ Memorial Trust Fund —The

March of Dimes Fund . . . . . . . . . . . . . . .08

Workers

purchase the popular “prevent child abuse”

Workers’ Memorial Fund has been es-

Muscular Dystrophy Association Fund . .07

license plate featuring the handprints logo.

tablished to create a permanent memorial

National Multiple Sclerosis Society

For more information, please contact:

for all workers who suffered a job related death

Fund . . . . . . . . . . . . . . . . . . . . . . . . .10

Children’s Trust Fund, P.O. Box 1641, Jefferson

or injuries that resulted in a permanent disability

City, MO 65102-1641, or call (573) 751-

while on the job in Missouri. The memorial will

American Cancer Society Heartland

5147. (Minimum contribution: $2, or $4 if

be located on the grounds of the state capitol.

Division, Inc., Fund (01) —

For

married filing combined)

Requests for information and contributions may

more information anytime, call toll

be made at any time directly to Workers’

free 1-800-ACS-2345 or visit

Veterans Trust Fund — The Veterans

Memorial Fund, ATTN: Office of Administra-

Donations can be sent directly to the American

Trust Fund expands the Missouri

tion, 301 W. High St., Room 570, Jefferson City,

Cancer Society at 1100 Pennsylvania Avenue,

Veterans Commission’s ability to pro-

MO 65101. (Minimum contribution: $1, or $2

Kansas City, MO 64105. (Minimum irrevocable

vide quality healthcare at its seven veterans

contribution: $1, not to exceed $200)

if married filing combined)

homes and to assist veterans and dependents

American Diabetes Associa-

Childhood Lead Testing Fund — The

through its Service to Veterans Program.

tion Gateway Area Fund (02)

LEAD

Childhood Lead Testing Fund is used

Because of the availability of this fund, nursing

— Requests for information

to support the administration of child-

care staff receive specialized training and

may be made by calling 1-800-238-3594 or

hood lead programs, blood lead tests for

assistance for the treatment of residents suffer-

contacting Gateway Area Diabetes Association

uninsured children, educational materials,

ing from Alzheimer’s, dementias, and other

Fund, 10820 Sunset Office Drive, St. Louis, MO

analysis of blood lead test reports and case

extraordinary ailments; and Veterans Service

63127. (Minimum irrevocable contribution: $1,

management. Lead poisoning affects children

Officers and Assistants receive comprehensive

not to exceed $200)

regardless of race, economic status or where

training relating to veterans benefits. Contribu-

they live.

Activities supported by this fund

American Heart Association Fund

tions may be made at any time directly to:

ensure that Missouri children at risk for lead

(03) — For more information, please

Veterans Trust Fund, c/o The Missouri Veterans

contact: American Heart Association,

poisoning are tested and receive appropriate

Commission, P.O. Drawer 147, Jefferson City,

follow-up activities to protect their health and

4643 Lindell Boulevard, St. Louis, MO 63108,

MO 65102-0147 or call (573) 751-3779.

or call (314) 367-3383. (Minimum irrevocable

well being from the harmful effects of lead.

(Minimum contribution: $2, or $4 if married

contribution: $1, not to exceed $200)

Requests for information and contributions may

filing combined)

be made at any time directly to the Missouri

American Lung Association of Missouri

Elderly Home Delivered Meals Trust

Department of Health and Senior Services,

Fund (04) — For more information,

Fund — The Elderly Home Delivered

Childhood Lead Testing Fund, PO Box 570,

please contact: American Lung Asso-

Meals Trust Fund provides an oppor-

Jefferson City, MO 65102-0570.

(Minimum

ciation Missouri Fund, 1118 Hampton

tunity to support the home delivered meals

contribution: $1, or $2 if married filing

Avenue, St. Louis, MO 63139-3196. (Mini-

program for Missouri’s senior citizens. More

combined)

mum irrevocable contribution: $1, not to

than 5.5 million meals are provided each year

exceed $200)

General Revenue Trust Fund —

to home bound senior citizens. These nutri-

eneral

Requests for information and contribu-

ALS Lou Gehrig’s Disease Fund

evenue

tionally balanced meals, delivered to the

tions may be made at any time directly

(05) — Call 1-888-873-8539 for

homes of seniors on the average of one meal

patient services in Eastern Missouri

to General Revenue Fund, ATTN: Department

per day, five days per week, help them live

and 1-800-878-2062 for patient

of Revenue, P.O. Box 3022, Jefferson City, MO

independently in their homes. The need for

services in Western Missouri. (Minimum irrev-

65105-3022. (Minimum contribution: $1, or

home delivered meals increases yearly as per-

ocable contribution: $1, not to exceed $200)

$2 if married filing combined)

sons are living longer and may need assistance.

Arthritis Foundation Fund

For more information, please contact: Elderly

Missouri Military

Military Family Relief

Family Relief Fund

(09) — Call 1-800-402-2491

Home Delivered Meals Trust Fund, c/o

Fund — For more infor-

and/or visit

Division of Senior Services and Regulation,

mation, please contact:

Missouri Military

Contributions can be made at any time directly

P.O. Box 570, 912 Wildwood Dr., Jefferson

Family Relief Fund, 2302 Militia Drive, ATTN:

to the Arthritis Foundation, 9433 Olive Blvd.,

City, MO 65102, or call (573) 526-8567.

JFMO-J1/SS, Jefferson City, MO 65201-1203.

Suite 100, St. Louis, MO 63132. (Minimum

(Minimum contribution: $2, or $4 if married

(Minimum contribution: $1, or $2 if married fil-

irrevocable contribution: $1, not to exceed

filing combined)

ing combined)

$200)

Missouri National Guard Trust Fund —

Additional Trust Funds

Cervical

Cancer

Prevention

The Missouri National Guard Trust

If you choose to give to additional trust funds,

Program (12) — For more infor-

Fund expands the capability to pro-

enter the two-digit additional trust fund code

mation, contact the Missouri

vide/coordinate Military Funeral Honors

(see below) in the spaces provided on Line

Department of Health and Senior

Ceremonies for veterans of Missouri and vet-

Services, Show Me Healthy

44. If you want to give to more than two addi-

erans buried in Missouri who have served

Women Program, P.O. Box 570, Jefferson City,

tional trust funds, please submit a contribu-

their country in an honorable manner.

MO 65102-0570 or call (573) 752-2845.

tion directly to the fund. For additional infor-

Military Funeral Honors may be composed of

(No

mation, see

“Two Member Detail” who may render hon-

minimum contribution; irrevocable trust fund)

Donations received from the following funds are

ors, fold, and present the United States of

March of Dimes Fund (08) —

designated specifically for Missouri residents.

America flag to primary next-of-kin, and

Send requests for information and

sound Taps; “Four Member Detail” who may

Trust Funds

Codes

contributions directly to the

render honors, fire volleys, sound Taps, and

American Cancer Society Heartland

Greater Missouri Chapter March of Dimes at

fold and present the United States of America

Division, Inc., Fund . . . . . . . . . . . . . .01

2001 S. Hanley Road, Suite 510, Brentwood,

flag to primary next-of-kin; or “Veterans’ Or-

American Diabetes Association

MO 63144. (Minimum irrevocable contribu-

ganization Detail” who may render honors,

Gateway Area Fund . . . . . . . . . . . . . .02

tion: $1, not to exceed $200)

fire volleys, sound Taps, and fold and present

American Heart Association Fund . . . . . .03

Muscular Dystrophy Associ-

the United States of America flag to primary

American Lung Association of

ation Fund (07) — Requests

next-of-kin. Contributions may be made at

Missouri Fund . . . . . . . . . . . . . . . . . .04

for information and contribu-

any time directly to Missouri National Guard

tions may be made at any time directly to:

Amyotrophic Lateral Sclerosis (ALS—Lou

Trust Fund, ATTN: JFMO-J1/SSH, 2302 Militia

MDA Missouri Divisional Office; 9200 Ward

Gehrig’s Disease) Fund . . . . . . . . . . .05

Drive, Jefferson City, MO 65101-1203 or call

Parkway, Suite 350; Kansas City, MO 64114-

Arthritis Foundation Fund . . . . . . . . . . . .09

(573) 638-9663. (Minimum contribution: $2,

3387; (816) 444-1554. (Minimum irrevocable

or $4 if married filing combined)

Cervical Cancer Fund . . . . . . . . . . . . . . .12

contribution: $1, not to exceed $200)

Form Mo-1040 And Mo-A Instructions - Missouri Department Of Revenue - 2006 Page 7

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