Form M1pr - Property Tax Refund - 2012
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1
2M1PR
Property Tax Refund 2012
20
1221
Please print and leave unused boxes blank. DO NOT USE STAPLES on anything you submit.
Your First Name and Initial
Last Name
Your Social Security Number
If a Joint Return, Spouse’s First Name and Initial
Last Name
Spouse’s Social Security Number
Mark
an X if a
foreign
Current Home Address (Street, Apartment Number, Route)
Your Date of Birth (mm/dd/yyyy)
address:
Mark an X if a
new address:
City
State
Zip Code
Spouse’s Date of Birth
Mark an X in
Nursing Home or Adult
Mobile Home
Renter
Homeowner
the oval boxes
Foster Care Resident
Owner
that apply:
State Elections Campaign Fund. If you did not designate on your
Your code:
Spouse’s code:
Political party and code number:
2012 Form M1, and you want $5 to go to help candidates for state
Republican . . . . . . . . . . . . . . . 11 Grassroots . . . . . . . . . . . . . . 14
offices pay campaign expenses, you may each enter the code number
Democratic/Farmer-Labor . . 12 Green . . . . . . . . . . . . . . . . . . . 15
for the party of your choice. This will not reduce your refund.
Independent . . . . . . . . . . . . . 13 General Campaign Fund . . . . 16
If a negative number, mark an X in oval
box.
1 Federal adjusted gross income (from line 37 of federal Form 1040,
.
00
line 21 of Form 1040A, or line 4 of Form 1040EZ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Nontaxable Social Security and/or Railroad Retirement Board benefits received
.
00
and not included in line 1 above (determine from instructions, page 8) . . . . . . . . . . . . . . . . . . . . . . 2
3 Deduction for payments made to an IRA, Keogh, Simplified Employee Pension (SEP) or
.
00
SIMPLE plan (add lines 28 and 32 of federal Form 1040 or from line 17 of Form 1040A) . . . . . . 3
4
Total welfare received, including MFIP
(Minnesota Family Investment Program),
MSA
(Minnesota Supplemental
.
00
SSI
GA
and GRH
. . . . . . . . .
4
Aid),
(Supplemental Security Income),
(General Assistance)
(Group Residential Housing)
5 Additional nontaxable income—such as 401(k) or deferred compensation plan contributions—
.
you must include (instructions, page 8). Enter income type(s) below: . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
00
.
00
6 Add lines 1 through 5. If your income is less than the rent you paid, enclose an explanation . . . . . 6
7 Subtraction amount (determine from instructions, page 9):
Mark an X if
65 or older:
From the worksheet in instructions, enter num-
you or your
ber of dependents from step C.
spouse are:
disabled:
Enter the name and Social Security number of each dependent below:
.
00
. . 7
8 Total household income. Subtract line 7 from line 6 (if result is zero
.
00
or less, leave blank). See income limits on page 9 of instructions, . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Renters: Line 3 of your 2012 Certificate(s) of Rent Paid (CRP).
.
00
Continue with line 10; this amount is not your refund (enclose your CRPs) . . . . . . . . . . . . . . . . . . . 9
10 Renters: Using the amounts on line 8 and line 9, find the amount to enter here from the
.
00
renters refund table on
pages 13–17
of the instructions. Continue with line 15 . . . . . . . . . . . . . 10
ALL HOMEOWNERS: REQUIRED — Property ID number (use numbers only):
County in which the property is located
.
00
11 Property tax from line 1 of Statement of Property Taxes Payable in 2013 . . . . . . . . . . . . . . . . . . . 11
(Mobile home owners: See instructions, page 7)
.
00
12 If claiming the special refund, enter amount from line 30, Schedule 1 (see inst., page 11) . . . 12
.
00
13 Subtract line 12 from line 11 (if result is zero or less, leave blank) . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Regular refund: Using the amounts on line 8 and line 13, find the amount to enter here
.
00
from the homeowners refund table on pages 18–26 of the instructions . . . . . . . . . . . . . . . . . . . 14
.
00
15 Add lines 10, 12 and 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
.
00
16 Nongame Wildlife Fund contribution. Your refund will be reduced by this amount . . . . . . . . . . . . 16
.
00
17 YOUR PROPERTY TAX REFUND. Subtract line 16 from line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
You must sign the second page. The direct deposit option is also on the second page.
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