Form Mo-Crp - Certification Of Rent Paid For - 2001

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2001
Attachment Sequence No. 1040-08 and 1040P-01
MISSOURI DEPARTMENT OF REVENUE
FORM
• Read instructions.
• Print or type.
CERTIFICATION OF RENT PAID FOR 2001
MO-CRP
1. SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
ARE YOU RELATED TO YOUR LANDLORD?
YES
NO
IF YES, EXPLAIN.
2. NAME
ADDRESS OF RENTAL UNIT (DO NOT LIST P.O. BOX)
3. LANDLORD’S NAME, SOCIAL SECURITY NO.
CITY, STATE, AND ZIP CODE
ADDRESS, CITY, STATE, AND ZIP CODE
4. HOW MANY PEOPLE, OTHER THAN YOU AND YOUR SPOUSE (IF APPLICABLE),
5. LANDLORD’S PHONE NUMBER
RESIDE AT THIS ADDRESS AND ARE AGE 18 OR OLDER? (SEE 8F BELOW.)
(
)
6. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
—
—
2001
—
—
2001
DURING YEAR
7. Enter your gross rent paid. Attach copies of your rent receipt(s) or
copies of cancelled checks (front and back) for rent paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
00
8. You may need to reduce your rent paid. Check the appropriate box and enter the percentage that is indicated on Line 8.
A. APARTMENT, HOUSE, MOBILE HOME, MOBILE HOME LOT, OR DUPLEX — 100%
B. BOARDING HOME / RESIDENTIAL CARE — 50%
C. SKILLED OR INTERMEDIATE CARE NURSING HOME — 45%
D. HOTEL If meals are included, enter — 50%; Otherwise, enter — 100%
E. LOW INCOME HOUSING — 100% (Rent cannot exceed 30% of total household income.)
F. SHARED RESIDENCE — If you shared your residence with relatives and/or friends (other than your spouse
%
or children under 18), enter the appropriate percentage of your home you occupied. . . . . . . . . . . . . . . . . . . . . . . . 8
9. Net rent paid. Multiply Line 7 by the percent on Line 8. ENTER HERE AND IN THE BOX ON
FORM MO-PTS, LINE 12 OR FORM MO-PTC, LINE 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
MO 860-1090 (11-2001)
2001
Attachment Sequence No. 1040-08 and 1040P-01
MISSOURI DEPARTMENT OF REVENUE
FORM
• Read instructions.
• Print or type.
CERTIFICATION OF RENT PAID FOR 2001
MO-CRP
1. SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
ARE YOU RELATED TO YOUR LANDLORD?
YES
NO
IF YES, EXPLAIN.
2. NAME
ADDRESS OF RENTAL UNIT (DO NOT LIST P.O. BOX)
3. LANDLORD’S NAME, SOCIAL SECURITY NO.
CITY, STATE, AND ZIP CODE
ADDRESS, CITY, STATE, AND ZIP CODE
4. HOW MANY PEOPLE, OTHER THAN YOU AND YOUR SPOUSE (IF APPLICABLE),
5. LANDLORD’S PHONE NUMBER
RESIDE AT THIS ADDRESS AND ARE AGE 18 OR OLDER? (SEE 8F BELOW.)
(
)
6. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
—
—
2001
—
—
2001
DURING YEAR
7. Enter your gross rent paid. Attach copies of your rent receipt(s) or
copies of cancelled checks (front and back) for rent paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
00
8. You may need to reduce your rent paid. Check the appropriate box and enter the percentage that is indicated on Line 8.
A. APARTMENT, HOUSE, MOBILE HOME, MOBILE HOME LOT, OR DUPLEX — 100%
B. BOARDING HOME / RESIDENTIAL CARE — 50%
C. SKILLED OR INTERMEDIATE CARE NURSING HOME — 45%
D. HOTEL If meals are included, enter — 50%; Otherwise, enter — 100%
E. LOW INCOME HOUSING — 100% (Rent cannot exceed 30% of total household income.)
F. SHARED RESIDENCE — If you shared your residence with relatives and/or friends (other than your spouse
%
or children under 18), enter the appropriate percentage of your home you occupied. . . . . . . . . . . . . . . . . . . . . . . . . 8
9. Net rent paid. Multiply Line 7 by the percent on Line 8. ENTER HERE AND IN THE BOX ON
FORM MO-PTS, LINE 12 OR FORM MO-PTC, LINE 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
MO 860-1090 (11-2001)

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