Form M99 - Credit For Military Service In A Combat Zone - 2012

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1299

Form M99, Credit for Military Service in a Combat Zone 2012

First name and initial

Last name

Social Security number

Mark

Current home address (street, apartment number, route)

Date of birth (mm/dd/yyyy)

an X if a

foreign

address:

City

State

Zip code

Mark an X if this is

an amended Form M99

Enter the number of months served in a combat zone for the year 2012. Count partial months as full months. Your home of record must

have been Minnesota during the months served to qualify for the credit.

1 Number of months in 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

2 Multiply line 1 by $120. This is the AMOUNT OF YOUR CREDIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

For Direct Deposit of the full credit, enter the following information. Otherwise, you will receive a check.

(You must use an account not associated with a foreign bank.)

Account type:

Routing number

Account number

Checking

Savings

Sign here: I declare that this return is correct and complete to the best of my knowledge and belief.

Your signature

Date

Phone