Form Mi-1040cr-7 - Michigan Home Heating Credit Claim - 2014
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Michigan Department of Treasury (Rev. 09-14), Page 1 of 2
Issued under authority of Public Act 281 of 1967, as amended.
2014 MICHIGAN Home Heating Credit Claim MI-1040CR-7
1 4
0123456789
Type or print in blue or black ink. Print numbers like this
- NOT like this:
Attachment 08
:
1. Filer’s First Name
M.I.
Last Name
2. Filer’s Full Social Security No. (Example: 123-45-6789)
If a Joint Return, Spouse’s First Name
M.I.
Last Name
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street or P.O. Box)
City or Town
State
ZIP Code
4. County Code (see instr.)
5. 2014 FILING STATUS:
6. 2014 RESIDENCY STATUS:
*If you checked box “c,” enter dates of Michigan residency in 2014.
Check one.
Check all that apply.
Enter dates as MM-DD-YYYY (Example: 04-15-2014).
FILER
SPOUSE
a.
Single
a.
Resident
2014
2014
FROM:
Married filing jointly
b.
b.
Nonresident
2014
2014
TO:
Married filing separately
c.
c.
Part-Year Resident*
(Attach Form 5049)
13. Exemptions. Enter the number that applies to you,
7. Check the box if your heating costs are currently included in your
your spouse, or your dependents and complete line
rent (see instructions) ........................................................................
14 below. See instructions if you are over age 66.
8. Check the box if you want your name and address referred to
Personal Exemption
..........................
a.
other government assistance programs for which you may qualify.
(You and your spouse only)
Deaf, Disabled or Blind ...................
b.
9. Check the box if you or your spouse now receive
Supplemental Security Income (SSI)........................................
Qualified Disabled Veteran ............
c.
Filer
Spouse
Number of children living with you:
10. ENTER YOUR AGE if you are age 60 or older ...
Ages 2 and under .......................
d.
=
Ages 3-5......................................
e.
=
11. Amount you were billed for
heat between 11/1/2013 and 10/31/2014 .........
00
Ages 6-18....................................
f.
12. If you lived in one of these CARE facilities (not a senior apartment
=
complex) for all of 2014, check the box and STOP here, see instructions.
Dependent adults, other than
a.
Nursing Home
b.
Adult Foster Care Home
your spouse, who live with you .......
g.
c.
Licensed Home for the Aged
d.
Substance Abuse Center
Add lines 13a through 13g..............
h.
14.
You MUST enter below the name, relationship, Social Security number, and age of all dependents you claimed in lines 13d - 13g above.
A. Dependent’s Name
B. Dependent’s Relationship to You
C. Social Security Number
D. Age in Years
If you have more than six (6) dependents, complete Home Heating Credit Claim MI-1040CR-7 Supplemental (Form 4976).
15.
You must check this box to receive a refund from your heat provider for
any overpayment to your heat account, if eligible (see instructions).
+
0000 2014 37 01 27 4
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