CM
Schedule
Community Rehabilitation
Program Credit
2012
Enclose with Wisconsin Form 1, 1NPR, 2, 3, 4, 4T, 5, or 5S
Wisconsin Department
Read instructions before filling in this form
of Revenue
Name
Identifying Number
Part I – To be completed by claimant
1
Enter amount paid in the taxable year to a community rehabilitation
program to perform work for your business. Do not fill in more than $500,000
1
2
Multiply line 1 by 5% (0.05). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3
If you paid an amount to more than one community rehabilitation program
to perform work for your business, fill in the amount from line 2 of any
additional Schedules CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4
Enter community rehabilitation program credit passed through from other
entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5
Add lines 2, 3, and 4. This is your 2012 credit (see instructions) . . . . . . . . . . 5
5a Fiduciaries – enter the amount of credit allocated to beneficiaries . . . . . . . . . 5a
5b Fiduciaries – subtract line 5a from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b
6
Carryover of unused community rehabilitation program credit . . . . . . . . . . . . 6
Add lines 5 and 6 (lines 5b and 6 if fiduciary). This is the available
7
community rehabilitation program credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Part II – To be completed by the community rehabilitation program
1
Name and address of entity providing the community rehabilitation program
2
Name of entity for which work was provided
3
Taxable year of entity beginning
, 2012, and ending
, 20
4
Date contract signed
5
Total payments received during the period listed in 3 above
6
Amount of payments in 5 above that was for work performed
►
Authorized community rehabilitation program representative
Date
Sign
Here
IC-234