Instructions For Form Mo-1040p - Property Tax Credit/ Pension Exemption Short Form - 2012 Page 24
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322012
FAILURE TO PROVIDE LANDLORD
MISSOURI DEPARTMENT OF REVENUE
INFORMATION WILL RESULT IN
FORM
CERTIFICATION OF RENT PAID FOR 2012
MO-CRP
DENIAL OR DELAY OF YOUR CLAIM.
1. SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
ARE YOU RELATED TO YOUR LANDLORD?
_ _ _ - _ _ - _ _ _ _
_ _ _ - _ _ - _ _ _ _
YES
NO
IF YES, EXPLAIN.
2. NAME
3. LANDLORD’S NAME, LAST 4 DIGITS OF SSN, OR FEIN (MUST BE COMPLETED)
PHYSICAL ADDRESS OF RENTAL UNIT (P.O. BOX NOT ALLOWED)
APT. NUMBER
LANDLORD’S ADDRESS, CITY, STATE, AND ZIP CODE (MUST BE COMPLETED)
APT. NUMBER
CITY, STATE, AND ZIP CODE
4. LANDLORD’S PHONE NUMBER (MUST BE COMPLETED)
(__ __ __) __ __ __ - __ __ __ __
5. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
2012
2012
—
—
—
—
DURING YEAR
6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement from your landlord,
or copies of cancelled checks (front and back). If you received housing assistance, enter the amount of rent YOU paid.
00
NOTE: If you rent from a facility that does not pay property tax, you are not eligible for a Property Tax Credit. . ...............
6
7. Check the appropriate box and enter the corresponding percentage on Line 7.
A. A PARTMENT, HOUSE, MOBILE HOME, OR DUPLEX — 100%
B. MOBILE HOME LOT — 100%
C. BOARDING HOME / RESIDENTIAL CARE — 50%
D. S KILLED OR INTERMEDIATE CARE NURSING HOME — 45%
E. H OTEL If meals are included, enter — 50%; Otherwise, enter — 100%
F. LOW INCOME HOUSING — 100% (RENT CANNOT EXCEED 40% OF TOTAL HOUSEHOLD INCOME.)
G. SHARED RESIDENCE — If you shared your rent with relatives or friends (OTHER THAN YOUR SPOUSE
OR CHILDREN UNDER 18), check the appropriate box and enter percentage.
%
Additional persons sharing rent/percentage to be entered:
1 (50%)
2 (33%)
3 (25%) . ........ 7
00
. ...........................................................................................
8. Net rent paid — Multiply Line 6 by the percentage on Line 7.
8
00
9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS. . .......................... 9
For Privacy Notice, see instructions.
MO-CRP (12-2012)
2012
FAILURE TO PROVIDE LANDLORD
MISSOURI DEPARTMENT OF REVENUE
INFORMATION WILL RESULT IN
FORM
CERTIFICATION OF RENT PAID FOR 2012
MO-CRP
DENIAL OR DELAY OF YOUR CLAIM.
1. SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
ARE YOU RELATED TO YOUR LANDLORD?
_ _ _ - _ _ - _ _ _ _
_ _ _ - _ _ - _ _ _ _
YES
NO
IF YES, EXPLAIN.
2. NAME
3. LANDLORD’S NAME, LAST 4 DIGITS OF SSN, OR FEIN (MUST BE COMPLETED)
PHYSICAL ADDRESS OF RENTAL UNIT (P.O. BOX NOT ALLOWED)
LANDLORD’S ADDRESS, CITY, STATE, AND ZIP CODE (MUST BE COMPLETED)
APT. NUMBER
APT. NUMBER
4. LANDLORD’S PHONE NUMBER (MUST BE COMPLETED)
CITY, STATE, AND ZIP CODE
(__ __ __) __ __ __ - __ __ __ __
5. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
2012
2012
—
—
—
—
DURING YEAR
6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement from your landlord,
or copies of cancelled checks (front and back). If you received housing assistance, enter the amount of rent YOU paid.
00
NOTE: If you rent from a facility that does not pay property tax, you are not eligible for a Property Tax Credit. . ...............
6
7. Check the appropriate box and enter the corresponding percentage on Line 7.
A. A PARTMENT, HOUSE, MOBILE HOME, OR DUPLEX — 100%
B. MOBILE HOME LOT — 100%
C. BOARDING HOME / RESIDENTIAL CARE — 50%
D. S KILLED OR INTERMEDIATE CARE NURSING HOME — 45%
E. H OTEL If meals are included, enter — 50%; Otherwise, enter — 100%
F. LOW INCOME HOUSING — 100% (RENT CANNOT EXCEED 40% OF TOTAL HOUSEHOLD INCOME.)
G. SHARED RESIDENCE — If you shared your rent with relatives or friends (OTHER THAN YOUR SPOUSE
OR CHILDREN UNDER 18), check the appropriate box and enter percentage.
%
Additional persons sharing rent/percentage to be entered:
1 (50%)
2 (33%)
3 (25%) . ........ 7
00
8. Net rent paid — Multiply Line 6 by the percentage on Line 7.
. ...........................................................................................
8
00
9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS. . .......................... 9
For Privacy Notice, see instructions.
MO -CRP (12-2012)
24
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