Schedule M1psc - Credit For Parents Of Stillborn Children - 2017
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2017 Schedule M1PSC, Credit for Parents of Stillborn Children
Complete this schedule if you experienced the stillbirth of a child in 2017, received a Certificate of Birth Resulting in Stillbirth from Minnesota, and
the child would have been your dependent in 2017 if they had been born alive.
Your First Name and Initial
Last Name
Social Security Number
A Did you experience the birth of a stillborn child in 2017? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
B Do you have a Certificate of Birth Resulting in Stillbirth from the Minnesota Department of Health? . . . . . . . . . . . . . . . Yes
No
(If you answered no, but experienced the birth of a stillborn child in Minnesota in 2017, see instructions.)
C Would you have claimed the child as your dependent in 2017 had the child been born alive?
(If you answered no, stop here. You do not qualify for this credit.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes
No
Enter the following information. If you have a Certificate of Birth Resulting in Stillbirth for more than one child in 2017, complete a separate
schedule and include with your Form M1.
1 Name of Parent 1 on Certificate of Birth Resulting in Stillbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Name of Parent 2 on Certificate of Birth Resulting in Stillbirth (if listed) . . . . . . . . . . . . . . . . . . . . . 2
3 Date of delivery on the Certificate of Birth Resulting in Stillbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 State file number on the Certificate of Birth Resulting in Stillbirth . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Document control number on the Certificate of Birth Resulting in Stillbirth . . . . . . . . . . . . . . . . . 5
2,000
6 Credit allowed per child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Full-year residents: Include this amount on line 4 of Schedule M1REF.
7 Part-year residents and nonresidents: Multiply the amount on line 6 by line 25
of Schedule M1NR. Include the result here and on line 4 of Schedule M1REF.
However, if your Minnesota gross income is less than $10,400, see instructions;
enter the result from step 5 of the worksheet here:
Enter the result from step 6 on line 7 and on line 4 of Schedule M1REF . . . . . . . . . . . . . . . . . . . . . 7
You must include this schedule with your Form M1.
9995
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