Form Mo-Crp - Certification Of Rent Paid For - 2002

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2002
• Read instructions.
MISSOURI DEPARTMENT OF REVENUE
• Print or type.
FORM
CERTIFICATION OF RENT PAID FOR 2002
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
LANDLORD’S 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 FOR ENTIRE YEAR?
(
)
(SEE 8G BELOW.)
6. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
—
—
2002
—
—
2002
DURING YEAR
7. Enter your gross rent paid. Attach copies of your lease agreement(s) or copies of cancelled checks (front and back)
00
for rent paid. If receiving assistance, enter the amount of rent YOU paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8. Check the appropriate box and enter the corresponding percentage on Line 8.
A. APARTMENT, HOUSE, MOBILE HOME, OR DUPLEX — 100%
B. MOBILE HOME LOT — 100%
C. BOARDING HOME / RESIDENTIAL CARE — 50%
D. SKILLED OR INTERMEDIATE CARE NURSING HOME — 45%
E. HOTEL If meals are included, enter — 50%; Otherwise, enter — 100%
F. LOW INCOME HOUSING — 100%
(Rent cannot exceed 30% of total household income.)
G.
SHARED RESIDENCE
— If you shared your residence with relatives and/or friends
(other than your spouse
or children under
18), check the appropriate box and enter percentage.
%
Additional persons sharing residence/percentage to be entered:
1 (50%)
2 (33%)
3 (25%)
8
9. Net rent paid. Multiply Line 7 by the percentage on Line 8. ENTER HERE AND IN THE BOX ON
FORM MO-PTS, LINE 12 OR FORM MO-PTC, LINE 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
MO 860-1089 (11-2002)
2002
• Read instructions.
MISSOURI DEPARTMENT OF REVENUE
• Print or type.
FORM
CERTIFICATION OF RENT PAID FOR 2002
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
LANDLORD’S 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 FOR ENTIRE YEAR?
(
)
(SEE 8G BELOW.)
6. RENTAL PERIOD
FROM:
MONTH
DAY
YEAR
TO:
MONTH
DAY
YEAR
—
—
2002
—
—
2002
DURING YEAR
7. Enter your gross rent paid. Attach copies of your lease agreement(s) or copies of cancelled checks (front and back)
00
for rent paid. If receiving assistance, enter the amount of rent YOU paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8. Check the appropriate box and enter the corresponding percentage on Line 8.
A. APARTMENT, HOUSE, MOBILE HOME, OR DUPLEX — 100%
B. MOBILE HOME LOT — 100%
C. BOARDING HOME / RESIDENTIAL CARE — 50%
D. SKILLED OR INTERMEDIATE CARE NURSING HOME — 45%
E. HOTEL If meals are included, enter — 50%; Otherwise, enter — 100%
F. LOW INCOME HOUSING — 100%
(Rent cannot exceed 30% of total household income.)
G.
SHARED RESIDENCE
— If you shared your residence with relatives and/or friends
(other than your spouse
or children under
18), check the appropriate box and enter percentage.
%
Additional persons sharing residence/percentage to be entered:
1 (50%)
2 (33%)
3 (25%)
8
9. Net rent paid. Multiply Line 7 by the percentage on Line 8. ENTER HERE AND IN THE BOX ON
FORM MO-PTS, LINE 12 OR FORM MO-PTC, LINE 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
MO 860-1089 (11-2002)

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