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MO-1040 Page 1

For Calendar Year January 1 - December 31, 2017

Missouri Department of Revenue

2017 Individual Income

Tax Return - Long Form

Department Use Only

Form

MO-1040

Fiscal Year Beginning (MM/DD/YY) Fiscal Year Ending (MM/DD/YY)

Age 62 through 64

Yourself Spouse

Age 65 or Older Blind 100% Disabled Non-Obligated Spouse

Yourself Spouse Yourself Spouse Yourself Spouse Yourself Spouse

Select the appropriate boxes that apply, as of December 31, 2017.

Select Here for Amended Return

Print in BLACK ink only and DO NOT STAPLE.

NameAddress

If filing a fiscal year return enter the beginning and ending dates here.

Select Here for Composite Return

Social Security Number Spouse’s Social Security Number

- -

M.I.

In Care Of Name (Attorney, Executor, Personal Representative, etc.)

County of Residence

Present Address (Include Apartment Number or Rural Route)

City, Town, or Post Office

State ZIP Code

Last Name

in 2017

First Name Suffix

Spouse’s Last NameSpouse’s First Name

M.I.

Suffix

For Privacy Notice, see Instructions.

*17322010006*

17322010006

Veterans

Trust Fund

Children’s

Trust Fund

Elderly Home

Delivered Meals

Trust Fund

Missouri

National Guard

Trust Fund

Workers

Workers’

Memorial

Fund

LEAD

Childhood

Lead Testing

Fund

Missouri Military

Family Relief

Fund

General

Revenue

General

Revenue

Fund

Organ Donor

Program Fund

You may contribute to any one or all of the trust funds on Line 48. See pages 10-11 of the instructions for more trust fund information.

DeceasedDeceased

in 2017

Name

(For use by S corporations or Partnerships)

- -

MO-1040 Page 1

Vendor Code

0 6

Print Form

Reset

Calculate

Do automatic calculations

Don't do any calculations

(NOTE: For proper form functionality, utilize Internet Explorer

browser and Adobe Reader for PDF viewer)

INSTRUCTIONS:

- Enter numbers without decimals (integers)

- Don't forget to attach all required forms

- You can tab from one field to another or use the mouse to click in

the field you want.

- Use the print button at the top of page to print form

- Click on the blue boxes to prepopulate an amount.

- Click on the gray boxes to view the instructions for that line.

- If a field does not allow a negative number and a negative number

is entered, a zero will be displayed.

SELECT COUNTY

For Privacy Notice CLICK HERE

MO-1040 Page 2

6. Total Missouri adjusted gross income - Add columns 5Y and 5S ...........

7. Income percentages - Divide columns 5Y and 5S by total on

Line 6. (Must equal 100%) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exemptions and Deductions

x $1,200 =

8. Pension, Social Security, Social Security Disability, and Military exemption (from Form

MO-A, Part 3, Section E) ........................................................

9. Select your filing status box below. Enter the appropriate exemption amount on Line 9 .......

10. Additional personal exemption (see instructions on page 7) .............................

12. Other tax from federal return - Attach a copy of your federal return

13. Total tax from federal return - Add Lines 11 and 12 ............

14. Federal tax deduction - Enter the amount from Line 13, not to exceed $5,000 for an individual

filer or $10,000 for combined filers ................................................

15. Missouri standard deduction or itemized deductions.

(pages 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. Number of dependents (from Federal Form 1040 or 1040A, Line 6c).

17. Number of dependents on Line 16 who are 65 years of age or older and do

not receive Medicaid or state funding. Do not include yourself or spouse .. x $1,000 =

Select box if claiming a stillborn child (see instructions on page 8).

• Single or Married Filing Separate - $6,350

• Head of Household - $9,350

*17322020006*

17322020006

Income

Yourself (Y) Spouse (S)

1. Federal adjusted gross income from your 2017 federal

return (see worksheet on page 7 of the instructions) ........

2. Total additions (from Form MO-A, Part 1, Line 7) . . . . . . . . . .

3. Total income - Add Lines 1 and 2.......................

4. Total subtractions (from Form MO-A, Part 1, Line 17) .......

5. Missouri adjusted gross income - Subtract Line 4 from Line 3..

• Married Filing Combined or Qualifying Widow(er) - $12,700

If age 65 or older, blind, claimed as a dependent, see page 8. If itemizing, see Form MO-A, Part 2.

A. Single - $2,100 (see Box B before selecting.)

B. Claimed as a Dependent on Another Person’s

Federal Tax Return - $0.00

C. Married Filing Combined (joint federal) - $4,200

D. Married Filing Separate - $2,100

E. Married Filing Separate (spouse NOT filing) - $4,200

F. Head of Household - $3,500

G. Qualifying Widow(er) with Dependent Child - $3,500

Do not include yourself or spouse................................

MO-1040 Page 2

11. Tax from federal return - Do not enter federal income tax

withheld (see instructions on page 7 and 8)..................

Worksheet

Line 1

MO-A

Line 2

MO-A

Line 4

Line 7

MO-A

Line 8

Line 9

Line 10

Line 11

Line 12

Line 14

Itemized Deductions Worksheet

Line 15

Line 16

Line 17

MO-1040 Page 3

*17322030006*

17322030006

Tax

27S

27Y

27. Taxable income - Subtract Line 26 from Line 25...........

28S

28Y

28. Tax (see tax chart on page 20 of the instructions)..........

29S

29Y

income tax return(s).................................

29. Resident credit - Attach Form MO-CR and other states’

completing Form MO-NRI. Attach Form MO-NRI and a

30. Missouri income percentage - Enter 100% unless you are

copy of your federal return if less than 100% .............

31S

31Y

multiply Line 28 by percentage on Line 30 ...............

31. Balance - Subtract Line 29 from Line 28; OR

32S

32Y

32. Other taxes - Select box and attach federal form indicated.

Lump sum distribution (Form 4972)

Recapture of low income housing credit (Form 8611)

33S

33Y

33. Subtotal - Add Lines 31 and 32 ........................

34. Total Tax - Add Lines 33Y and 33S................................................

Payments and Credits

35. MISSOURI tax withheld - Attach Forms W-2 and 1099.................................

36. 2017 Missouri estimated tax payments - Include overpayment from 2016 applied to 2017 ........

37. Missouri tax payments for nonresident partners or S corporation shareholders - Attach Forms

MO-2NR and MO-NRP .........................................................

22. Transportation facilities deduction .................................................

Exemptions and Deductions (cont.)

21. Bring jobs home deduction ......................................................

18. Long-term care insurance deduction ...............................................

19. Health care sharing ministry deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20. Military income deduction .......................................................

30S %30Y %

MO-1040 Page 3

23. Total deductions - Add Lines 8, 9, 10, and 14 through 22...............................

24. Subtotal - Subtract Line 23 from Line 6 .............................................

26S

26Y

26. Enterprise zone or rural empowerment zone income

modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25. Multiply Line 24 by appropriate percentages (%) on

25S

25Y

Lines 7Y and 7S ...................................

A. Port Cargo Expansion B. International Trade Facility C. Qualified Trade Activities

Long-term Care Worksheet

Line 18

Line 19

Line 20

Line 21

Line 22

Line 24

Line 26

Line 28

MO-CR

Line 29

MO-NRI

100

Line 30

Line 32

Line 35

Line 36

Line 37

MO-1040 Page 4

Refund

46. If Line 42, or if amended return, Line 45, is larger than Line 34, enter the difference.

Amount of OVERPAYMENT .........................................................

47. Amount of Line 46 to be applied to your 2018 estimated tax ............................

48. Enter the amount of your donation in the trust fund boxes below. See instructions for additional trust fund codes.

49. Amount of Line 46 to be deposited into a Missouri 529 College Savings Plan (MOST)

account. Enter amount from Line E of Form 5632 ....................................

*17322040006*

17322040006

Skip Lines 43 through 45 if you are not filing an amended return.

43. Amount paid on original return....................................................

44. Overpayment as shown (or adjusted) on original return ................................

D. Correction other than A, B, or C .......

Indicate Reason for Amending

A. Federal audit......................

B. Net operating loss carryback .........

C. Investment tax credit carryback .......

45. Amended return total payments and credits - Add Line 43 to Line 42 or subtract Line 44

from Line 42..................................................................

Enter date of federal amended return, if filed. (MM/DD/YY)

Enter year of credit (YY)

Enter year of loss (YY)

Enter date of IRS report (MM/DD/YY)

Children’s

Trust Fund

Veterans

Trust Fund

Elderly Home

Delivered Meals

Trust Fund

Missouri

National Guard

Trust Fund

Workers’

Memorial Fund

Childhood

Lead

Testing Fund

General

Revenue Fund

Organ Donor

Program Fund

Missouri

Military Family

Relief Fund

Total Donation - Add amounts from Boxes 48a through 48k and enter here.................

40. Miscellaneous tax credits (from Form MO-TC, Line 13) - Attach Form MO-TC ..............

41. Property tax credit - Attach Form MO-PTS ..........................................

42. Total payments and credits - Add Lines 35 through 41 .................................

48a. 48b. 48c.

48d. 48e. 48f.

48g. 48h. 48i.

48j.

Payments and Credits

Additional

Fund

Code

Additional

Fund

Amount

48k.

Additional

Fund

Code

Additional

Fund

Amount

39. Amount paid with Missouri extension of time to file (Form MO-60)........................

38. Missouri tax payments for nonresident entertainers - Attach Form MO-2ENT ...............

Amended Return

MO-1040 Page 4

Line 38

Line 39

MO-TC

Line 40

MO-PTS

Line 41

Line 43

Line 44

These fields are locked.

To unlock them, Click on

the "amended" check box

on page 1 of this form (top

left).

Line 45

Line 46

Line 48

48 part2

MOST

Yes No

Preparer’s Telephone

Signature

Preparer’s Signature

Spouse’s Signature (If filing combined, BOTH must sign)

Daytime Telephone

Date (MM/DD/YY)

Preparer’s Address ZIP CodeState

Mail To: Balance Due: Refund or No Amount Due: Phone (Balance Due): (573) 751-7200

Missouri Department of Revenue Missouri Department of Revenue Phone (Refund or No Amount Due): (573) 751-3505

P.O. Box 3370 P.O. Box 3222 Fax: (573) 751-2195

Jefferson City, MO 65105-3370 Jefferson City, MO 65105-3222 E-mail: income@dor.mo.gov

(Revised 12-2017)

I authorize the Director of Revenue or delegate to discuss my return and attachments with the preparer

or any member of the preparer’s firm

........................................................

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the

best of my knowledge and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all

information of which he or she has any knowledge. As provided in Chapter 143, RSMo, a penalty of up to $500 shall be imposed on

an individual who files a frivolous return. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as

E-mail Address

Preparer’s FEIN, SSN, or PTIN

Date (MM/DD/YY)

defined under federal law and that I am not eligible for any tax exemption, credit, or abatement if I employ such aliens.

*17322050001*

17322050001

electronically. Any returned check may be presented again electronically . . . . . . . . . . . . . . . . . .

Amount Due

51. If Line 34 is larger than Line 42 or Line 45, enter the difference.

Amount of UNDERPAYMENT (see the instructions for Line 52)........................

52. Underpayment of estimated tax penalty - Attach Form MO-2210. Enter penalty amount here ...

53. AMOUNT DUE - Add Lines 51 and 52.

If you pay by check, you authorize the Department of Revenue to process the check

50. REFUND - Subtract Lines 47, 48, and 49 from Line 46 and enter here ....................

Refund (cont.)Signature

FA E10A DE

Department Use Only

Select this box if you are a farmer exempt from the underpayment of estimated tax penalty.

MO-1040 Page 5

If you would like your refund deposited directly into your checking or savings account, complete boxes a, b, and c below.

a. Routing

Number

b. Account

Number

c. SavingsChecking

Line 50

Line 52

Line 53

Click here to finish

2017 Tax Chart

To identify your tax, use your Missouri taxable income from Form MO-1040, Line 27Y or 27S and the tax chart in Section

A below. A separate tax must be computed for you and your spouse.

Calculate your Missouri tax using the online tax calculator at http://dor.mo.gov/personal/individual or by using the

worksheet in Section B below. Round to the nearest whole dollar and enter on Form MO-1040, Line 28Y and 28S.

*17000000001*

17000000001

Section B Section A

Tax Rate Chart

Tax Calculation Worksheet

($61.98

rounded to the

nearest dollar)

($490.68

rounded to the

nearest dollar)

If the Missouri taxable income is: The tax is:

$0 to $100

................................................ $0

At least $101 but not over $1,008.............................. 1½% of the Missouri taxable income

Over $1,008 but not over $2,016 .............................. $15 plus 2% of excess over $1,008

Over $2,016 but not over $3,024 .............................. $35 plus 2½% of excess over $2,016

Over $3,024 but not over $4,032 .............................. $60 plus 3% of excess over $3,024

Over $4,032 but not over $5,040 .............................. $90 plus 3½% of excess over $4,032

Over $5,040 but not over $6,048 .............................. $125 plus 4% of excess over $5,040

Over $6,048 but not over $7,056 .............................. $165 plus 4½% of excess over $6,048

Over $7,056 but not over $8,064 .............................. $210 plus 5% of excess over $7,056

Over $8,064 but not over $9,072 .............................. $260 plus 5½% of excess over $8,064

Over $9,072 .............................................. $315 plus 6% of excess over $9,072

2017

Missouri Taxes Withheld

Earnings Tax

Diagram 1: Form W-2

Yourself Spouse Example A Example B

1. Missouri taxable income (Form MO-1040,

Line 27Y and 27S)..........................

_____________ _____________

$ 3,090 $ 12,000

2. Enter the minimum taxable income for your tax

bracket (see Section A above) ................

- $

_____________ _____________

- $ 3,024 $ 9,072

3. Difference - Subtract Line 2 from Line 1 . . . . . . . . .

= $

_____________ _____________

= $ 66 $ 2,928

4. Enter the percent for your tax bracket (see

Section A above)...........................

_____________

X 3% 6%

5. Multiply Line 3 by the percent on Line 4 .........

= $

_____________ _____________

= $ 1.98 $ 175.68

6. Enter the tax from your tax bracket - before

applying the percent (see Section A above) . . . . . .

+ $

_____________ _____________

+ $ 60 $ 315

7. Total Missouri Tax - Add Line 5 and 6. Enter here

and on Form MO-1040, Line 28Y and 28S .......

= $

_____________ _____________

= $ 62 $ 491

0.0

0.00

For Privacy Notice CLICK HERE

MO Public-Private Transportation Act

*17340010001*

17340010001

Missouri Department of Revenue

2017 Individual Income Tax Adjustments

Department Use Only

(MM/DD/YY)

Form

MO-A

1. Interest on state and local obligations other than Missouri source....

Other (description)

4. Food Pantry contributions included on Federal Schedule A.........

Part 1 - Missouri Modifications to Federal Adjusted Gross Income

Attach to Form MO-1040. Attach your federal return. See information beginning on page 12 to assist you in completing this form.

Additions

3. Nonqualified distribution received from a qualified 529 plan (higher

education savings program) not used for qualified expenses.........

6. Nonqualified distribution received from a qualified Achieving a Better

Life Experience Program (ABLE) not used for qualified expenses.....

7. Total Additions - Add Lines 1 through 6. Enter here and on Form

Subtractions

8. Interest from exempt federal obligations included in federal adjusted

gross income - Attach a detailed list or all Federal Form(s) 1099 .....

9. Any state income tax refund included in federal adjusted gross income.

Other (description)

11. Exempt contributions made to a qualified 529 plan (higher education

savings program) .........................................

2. Partnership Fiduciary S Corporation

Net Operating Loss (Carryback/Carryforward)

5. Nonresident Property Tax...................................

Partnership Fiduciary S Corporation 10.

Build America and Recovery Zone Bond Interest

Railroad Retirement Benefits

Net Operating Loss

Military (nonresident) Combat Pay

10Y

10S

11Y

11S

Social Security Number Spouse’s Social Security Number

M.I.

Last Name

First Name Suffix

Spouse’s Last NameSpouse’s First Name

M.I.

Suffix

Name

MO-1040, Line 2..........................................

12. Qualified Health Insurance Premiums - Attach the Qualified Health

12Y

12S

Insurance Premiums Worksheet (Form 5695) and supporting

- - - -

Spouse (S)Yourself (Y)

For Privacy Notice, see instructions.

documentation ...........................................

MO-A Page 1

Line 1

Line 2

Line 3

Line 4

Line 5

Line 7

Back to 1040 Page 2

Line 8

Line 9

Line 10

Line 11

Qualified Health Insurance Premiums Worksheet

Line 12

Line 6

For Privacy Notice CLICK HERE

Complete this worksheet only if your federal adjusted gross income from Federal Form 1040, Line 37 is more than $313,800 if married filing

combined or qualifying widow(er), $287,650 if head of household, $261,500 if single or claimed as a dependent, or $156,900 if married filing

separate. Attach your Federal Itemized Deduction Worksheet (page A-12 of Federal Schedule A instructions).

Part 2 - Missouri Itemized Deductions

1. Total federal itemized deductions from Federal Form 1040, Line 40 ................................

3. 2017 Social security tax - (Spouse) ..........................................................

4. 2017 Railroad retirement tax - Tier I and Tier II (Yourself) ........................................

5. 2017 Railroad retirement tax - Tier I and Tier II (Spouse) ........................................

6. 2017 Medicare tax - Yourself and Spouse (see instructions on page 42) ............................

7. 2017 Self-employment tax (see instructions on page 42) ........................................

8. Total - Add Lines 1 through 7 ..............................................................

9. State and local income taxes from Federal Schedule A, Line 5 or see

10. Earnings taxes included in Line 9 ............................

11. Net state income taxes - Subtract Line 10 from Line 9 or enter Line 8 from worksheet below ............

12. Missouri Itemized Deductions - Subtract Line 11 from Line 8. Enter here and on Form MO-1040, Line 15 ..

Part 2 Worksheet - Net State Income Taxes, Line 11

1. Enter amount from Federal Itemized Deduction Worksheet, Line 3 (see page A-12 of Federal Schedule A

instructions). If $0 or less, enter “0” .........................................................

3. State and local income taxes from Federal Form 1040, Schedule A, Line 5 ..........................

4. Earnings taxes included on Federal Form 1040, Schedule A, Line 5................................

5. Subtract Line 4 from Line 3 ...............................................................

6. Divide Line 5 by Line 1 ...................................................................

7. Multiply Line 2 by Line 6 ..................................................................

8. Subtract Line 7 from Line 5. Enter here and on Form MO-A, Part 2, Line 11. .........................

*17340020001*

17340020001

Part 1 Continued

2. 2017 Social security tax - (Yourself) .........................................................

Complete this section only if you itemize deductions on your federal return. Attach your Federal Form 1040 (pages 1 and 2) and Federal Schedule A.

2. Enter amount from Federal Itemized Deduction Worksheet, Line 9 (see Federal Schedule A instructions) ..

17. Total Subtractions - Add Lines 8 through 16. Enter here and on

Form MO-1040, Line 4 .....................................

16. Agriculture Disaster Relief ..................................

15. Exempt contributions made to a qualified Achieving a Better Life

Experience Program (ABLE) ................................

Sold or disposed property previously taken as addition modification

13. Missouri depreciation adjustment (Section 143.121, RSMo)

14. Home Energy Audit Expenses - Attach the Home Energy Audit

13Y

13S

14Y

14S

15Y

15S

16Y

16S

17Y

17S

the worksheet below.......................................

Expense (Form MO-HEA) ..................................

MO-A Page 2

Line 13

HEA Worksheet

Line 14

Line 15

Line 16

Line 17

Back to 1040 Page 2

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7

Line 9

Line 10

Line 12

Carry amount to 1040 Line 15

Use data from worksheet

Reset Worksheet

For Privacy Notice CLICK HERE

1 through 8 of Section C, and enter the amount(s) from Line(s) 6Y

5. Subtract Line 4 from Line 3 and enter on Line 5. If Line 4 is greater than Line 3, enter $0 ...............

6. Taxable pension for each spouse from public sources from Federal

7. Amount from Line 6 or $37,089 (maximum social security benefit),

Private Pension Calculation -

Annuities, pensions, IRAs, and 401(k) plans funded by a private source.

8. If you received taxable social security, complete Form MO-A, Lines

and 6S. See instructions if Line 3 of Section C is more than $0......

9. Subtract Line 8 from Line 7. If Line 8 is greater than Line 7, enter $0 .

10. Add amounts on Lines 9Y and 9S ..........................................................

11. Total public pension, subtract Line 5 from Line 10. If Line 5 is greater than Line 10, enter $0 ............

Section B

1. Missouri adjusted gross income from Form MO-1040, Line 6 .....................................

2. Taxable social security benefits from Federal Form 1040A, Line 14b or Federal Form 1040, Line 20b .....

3. Subtract Line 2 from Line 1 ...............................................................

4. Select the appropriate filing status and enter the amount on Line 4.

• Married Filing Combined (joint federal) - $32,000

5. Subtract Line 4 from Line 3. If Line 4 is greater than Line 3, enter $0 ...............................

7. Amounts from Line 6Y and 6S or $6,000, whichever is less ........

8. Add Lines 7Y and 7S .....................................................................

9. Total private pension, subtract Line 5 from Line 8. If Line 5 is greater than Line 8, enter $0...............

*17340030001*

17340030001

Form 1040A, Line 12b or 1040, Line 16b.......................

whichever is less .........................................

Public Pension Calculation -

Pensions received from any federal, state, or local government.

Part 3 - Pension and Social Security/Social Security Disability/Military Exemption

Section A

1. Missouri adjusted gross income from Form MO-1040, Line 6 .....................................

2. Taxable social security benefits from Federal Form 1040A, Line 14b or Federal Form 1040, Line 20b .....

3. Subtract Line 2 from Line 1 ...............................................................

6. Taxable pension for each spouse from private sources from

Federal Form 1040A, Lines 11b and 12b, or Federal Form 1040,

Lines 15b and 16b ........................................

• Single, Head of Household and Qualifying Widow(er) - $25,000

• Married Filing Separate - $16,000........................................................

4. Select the appropriate filing status and enter amount on Line 4.

• Married Filing Combined (joint federal) - $100,000

• Single, Head of Household, Married Filing Separate, and Qualifying Widow(er) - $85,000 ............

MO-A Page 3

Line 1

85,000

Line 8

Line 2

25,000

Line 6

For Privacy Notice CLICK HERE

Section D

Enter total amount here and on Form MO-1040, Line 8. .............................................

Military Pension Calculation

Total Pension and Social Security/Social Security Disability/Military Exemption

1. Military retirement benefits included on Federal Form 1040A, Line 12b or Federal Form 1040, Line 16b....

2. Taxable public pension from Federal Form 1040A, Line 12b or Federal Form 1040, Line 16b ............

3. Divide Line 1 by Line 2 (Round to whole number) ..............................................

4. Multiply Line 3 by Line 11 of Section A. If you are not claiming a public pension exemption, enter $0 ......

5. Total military pension, subtract Line 4 from Line 1 ..............................................

Section E

Add Line 11 (Section A), Line 9 (Section B), Line 8 (Section C), and Line 5 (Section D) from Form MO-A.

*17340040001*

17340040001

Section C

1. Missouri adjusted gross income from Form MO-1040, Line 6 .....................................

2. Select the appropriate filing status and enter the amount on Line 2.

• Married Filing Combined (joint federal) - $100,000

3. Subtract Line 2 from Line 1 and enter on Line 3. If Line 2 is greater than Line 1, enter $0 ...............

4. Taxable social security benefits for each spouse from Federal Form

5. Taxable social security disability benefits for each spouse from

6. Amount from Line(s) 4Y or 5Y, and 4S or 5S....................

7. Add Lines 6Y and 6S ....................................................................

8. Total social security/social security disability, subtract Line 3 from Line 7. If Line 3 is greater than Line 7,

enter $0 ..............................................................................

1040A, Line 14b or Federal Form 1040, Line 20b ................

Federal Form 1040A, Line 14b or 1040, Line 20b ................

Social Security or Social Security Disability Calculation -

To be eligible for social security deduction you must be 62 years of age by

• Single, Head of Household, Married Filing Separate, and Qualifying Widow(er) - $85,000 ............

December 31 and have selected the 62 and older box on page 1 of Form MO-1040. Age limit does not apply to social security disability deduction.

Attach to Form MO-1040. Attach your federal return.

See information beginning on page 12 to assist you in completing this form.

MO-A Page 4 (Revised 12-2017)

85,000

Line 4

Line 5

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Credit for Income Taxes Paid To

Other States or Political Subdivisions

Form

MO-CR

Name

Spouse’s Name

Yourself (Y) Spouse (S)

1. Claimant’s total adjusted gross income (Form MO-1040, Line 5Y

2. Claimant’s Missouri income tax (Form MO-1040, Line 28Y and

3. Wages and commissions................................

Total - Add Lines 3 and 4................................

6. Less, related adjustments (from Federal Form 1040A, Line 20,

7. Net amounts - Subtract Line 6 from Line 5 ..................

28S). Use the two letter abbreviation for the state or name of

8. Percentage of your income taxed - Divide Line 7 by Line 1 .....

9. Maximum credit - Multiply Line 2 by percentage on Line 8 . . . . . .

10. Income tax you paid to another state or political subdivision.

before entering on Form MO-1040 ........................

Attach Form MO-CR and all income tax returns for each state or political subdivision to Form MO-1040.

Complete this form if you or your spouse have income from another state or political subdivision. If you had multiple credits, complete a

separate form for each state or political subdivision.

State of:

Form MO-CR (Revised 12-2017)

*17313010001*

17313010001

4. Other income (Describe nature ________________________ ) ..

Social Security Number

Spouse’s Social Security Number

- -

11S

11Y

For Privacy Notice, see Instructions.

11. Credit - Enter the smaller amount of Line 9 or Line 10 here and

credits, add the amounts on Line 11 from each Form MO-CR

on Form MO-1040, Line 29Y or Line 29S. If you have multiple

all credits, except withholding and estimated tax..............

This is not income tax withheld. The income tax is reduced by

10S

10Y

7S7Y

or Federal Form 1040, Line 36)...........................

________________________________________________

abbreviation, or enter the name of the political subdivision below.

political subdivision. See the table on back for the two letter

and Line 5S) .........................................

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7

Line 8

Line 9

Line 10

Line 11

Back to MO-1040, page 3

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Credit for Income Taxes Paid To

Other States or Political Subdivisions

Form

MO-CR

Name

Spouse’s Name

Yourself (Y) Spouse (S)

1. Claimant’s total adjusted gross income (Form MO-1040, Line 5Y

2. Claimant’s Missouri income tax (Form MO-1040, Line 28Y and

3. Wages and commissions................................

Total - Add Lines 3 and 4................................

6. Less, related adjustments (from Federal Form 1040A, Line 20,

7. Net amounts - Subtract Line 6 from Line 5 ..................

28S). Use the two letter abbreviation for the state or name of

8. Percentage of your income taxed - Divide Line 7 by Line 1 .....

9. Maximum credit - Multiply Line 2 by percentage on Line 8 . . . . . .

10. Income tax you paid to another state or political subdivision.

before entering on Form MO-1040 ........................

Attach Form MO-CR and all income tax returns for each state or political subdivision to Form MO-1040.

Complete this form if you or your spouse have income from another state or political subdivision. If you had multiple credits, complete a

separate form for each state or political subdivision.

State of:

Form MO-CR (Revised 12-2017)

*17313010001*

17313010001

4. Other income (Describe nature ________________________ ) ..

Social Security Number

Spouse’s Social Security Number

- -

11S

11Y

For Privacy Notice, see Instructions.

11. Credit - Enter the smaller amount of Line 9 or Line 10 here and

credits, add the amounts on Line 11 from each Form MO-CR

on Form MO-1040, Line 29Y or Line 29S. If you have multiple

all credits, except withholding and estimated tax..............

This is not income tax withheld. The income tax is reduced by

10S

10Y

7S7Y

or Federal Form 1040, Line 36)...........................

________________________________________________

abbreviation, or enter the name of the political subdivision below.

political subdivision. See the table on back for the two letter

and Line 5S) .........................................

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Line 7

Line 8

Line 9

Line 10

Line 11

Back to MO-1040, page 3

For Privacy Notice CLICK HERE

Two Letter Abbreviations for States

Complete this form if you are a Missouri resident, resident estate, or resident trust with income from another state(s).

A part-year resident may elect to use this form to determine his or her tax as if he or she were a resident for the entire taxable

year. If you pay tax to more than one state, you must complete a separate Form MO-CR for each state.

Before you begin:

• Complete your Missouri return, Form MO-1040 (Lines 1 through 28).

• Complete the other state’s return(s) to determine the amount of income tax you paid to the other state(s).

Line 1 - Enter the amount from Form MO-1040, Line 5Y and 5S.

Line 2 - Enter the amount from Form MO-1040, Line 28Y and 28S.

Lines 3 and 4 - Enter the total amount of wages, commissions, and other income you or your spouse received from the other

state(s), as reported on the other state(s) return.

Line 5 - Add Lines 3 and 4; enter the total on Line 5.

Line 6 - Enter any federal adjustments from:

• Federal Form 1040, Line 36

• Federal Form 1040A, Line 20

Line 7 - Subtract Line 6 from Line 5. Enter the difference on Line 7.

Line 8 - Divide Line 7 by Line 1. If greater than 100 percent, enter 100 percent. Round in whole percent, such as 91 percent

instead of 90.5 percent. If percentage is less than 0.5 percent, use exact percentage. Enter percentage on Line 8.

Line 9 - Multiply Line 2 by percentage on Line 8. Enter amount on Line 9.

Line 10 - Enter your income tax liability as reported on the other state(s) income tax return. This is not income tax withheld. The

income tax entered must be reduced by all credits, except withholding and estimated tax. If both you and your spouse

paid income tax to the other state(s), each must claim his or her own portion of the tax liability.

Line 11 - Enter the smaller amount from Form MO-CR, Line 9 or Line 10. This is your Missouri resident credit. Enter the amount

on Form MO-1040, Line 29Y and 29S. (If you have multiple credits, add the amounts on Line 11 from each MO-CR).

Your total credit cannot exceed the tax paid or the percent of tax due to Missouri on that part of your income.

Information to complete Form MO-CR

*17000000001*

17000000001

- Alabama

AK - Alaska

AZ - Arizona

AR - Arkansas

CA - California

CO - Colorado

CT - Connecticut

DC - District of Columbia

DE - Delaware

FL - Florida

GA - Georgia

HI - Hawaii

ID - Idaho

IL - Illinois

IN - Indiana

IA - Iowa

KS - Kansas

KY - Kentucky

LA - Louisiana

ME - Maine

MD - Maryland

MA - Massachusetts

MI - Michigan

MN - Minnesota

MS - Mississippi

MT - Montana

NE - Nebraska

NV - Nevada

NH - New Hampshire

NJ - New Jersey

NM - New Mexico

NY - New York

NC - North Carolina

ND - North Dakota

OH - Ohio

OK - Oklahoma

OR - Oregon

PA - Pennsylvania

RI - Rhode Island

SC - South Carolina

SD - South Dakota

TN - Tennessee

TX - Texas

UT - Utah

VT - Vermont

VA - Virginia

WA - Washington

WV - West Virginia

WI - Wisconsin

WY - Wyoming

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Missouri Income Percentage

Form

MO-NRI

Attach Federal Return. See instructions

and diagram on page 3 of Form MO-NRI.

Part A

Resident/Nonresident Status - Select your status in the appropriate box below.

Name

Address

City, State, ZIP Code

Social Security Number

- -

Spouse’s Name

Address

City, State, ZIP Code

Spouse’s Social Security Number

- -

1. Nonresident of Missouri

State of residence during 2017 ______________________ State of residence during 2017 ______________________

2. Part-Year Missouri Resident

Indicate the dates you were a Missouri Resident in 2017. Indicate the dates you were a Missouri Resident in 2017.

A. Date From: _______________ Date To: _____________

B. Indicate the other state of residence

Based on the Military Spouse’s Residency Relief Act, if you are the spouse of a military servicemember residing outside of Missouri solely

because your spouse is there on military orders, and Missouri is your state of residence, any income you earn is taxable to Missouri. Do not

complete Form MO-NRI. You must report 100% on Line 30 of Form MO-1040.

3. Military/Nonresident Tax Status - Indicate your tax status

Missouri Home of Record

below and complete Part C - Missouri Income Percentage.

I did not at any time during the 2017 tax year maintain a

permanent place of abode in Missouri, nor did I spend more

than 30 days in Missouri during the year. I did maintain a

permanent place of abode in the state of

_____________ .

Non-Missouri Home of Record

I resided in Missouri during 2017 solely because my spouse

or I was stationed at

_____________________________

on military orders. My home of record is in the state of

and dates you resided there __________________________

B. Indicate the other state of residence

and dates you resided there __________________________

*17314010001*

17314010001

For Privacy Notice, see Instructions.

A. Date From: _______________ Date To: _____________

Date From: _______________ Date To: _____________ Date From: _______________ Date To: _____________

1. Nonresident of Missouri

2. Part-Year Missouri Resident

______________ .

3. Military/Nonresident Tax Status - Indicate your tax status

Missouri Home of Record

below and complete Part C - Missouri Income Percentage.

I did not at any time during the 2017 tax year maintain a

permanent place of abode in Missouri, nor did I spend more

than 30 days in Missouri during the year. I did maintain a

permanent place of abode in the state of

_____________ .

Non-Missouri Home of Record

I resided in Missouri during 2017 solely because my spouse

or I was stationed at

_____________________________

on military orders. My home of record is in the state of

______________ .

MO-NRI Page 1

Line 1

Line 2

Line 3

For Privacy Notice CLICK HERE

00Q

0000

Part B

Worksheet for Missouri Source Income

Adjusted Gross

Federal Form

Income Computations

A. Wages, salaries, tips, etc. .......................

B. Taxable interest income.........................

C. Dividend income ..............................

D. State and local income tax refunds ................

E. Alimony received ..............................

F. Business income or (loss) .......................

G. Capital gain or (loss) ...........................

H. Other gains or (losses)..........................

I. Taxable IRA distributions........................

J. Taxable pensions and annuities ..................

K. Rents, royalties, partnerships, S corporations, etc. ....

L. Farm income or (loss) ..........................

M. Unemployment compensation ....................

N. Taxablesocialsecuritybenets ...................

O. Other income .................................

P. Total - Add Lines A through O ....................

Q. Less: federal adjustments to income ...............

R. SUBTOTAL(LineP-LineQ)Ifnomodicationsto

S. Missourimodications-additionstofederaladjustedgrossincome

T. Missourimodications-subtractionsfromfederaladjustedgrossincome

income, enter this amount on Part C, Line 1 .........

(Missouri source from Form MO-1040, Line 2) ..............................

(Missouri source from Form MO-1040, Line 4) ..............................

U. MISSOURI INCOME (Missouri sources). Line R plus Line S, minus

Line T. Enter this amount on Part C, Line 1.................................

1040A,

Yourself or

One Income Filer

Spouse (On A

Combined Return)

Missouri Sources Missouri Sources

Line No.

Federal Form

1040,

Line No.

00T

00S

00R

00U

21 37

20 36

15 22

14b 20b

13 19

12b 16b

11b 15b

10 13

NONE 10

NONE

Part C

Missouri Income Percentage

1. Missouri Income - Enter wages, salaries, etc. from Missouri. (You must

 leaMissourireturniftheamountonthislineismorethan$600) ........

2. Taxpayer’s total adjusted gross income (From Form MO-1040, Lines 5Y

and 5S or from your federal form if you are a military nonresident and you

 arenotrequiredtoleaMissourireturn) ............................

3. Missouri Income Percentage - Divide Line 1 by Line 2. If greater than

100%, enter 100%. (Round to a whole percent such as 91% instead of

90.5% and 90% instead of 90.4%. However, if percentage is less than

0.5%, use the exact percentage.) Enter percentage here and on Form

3Y %

Yourself or

One Income Filer

Spouse

(On A Combined Return)

*17314020001*

17314020001

Signature

Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief it is true, correct, and complete.

Declaration of preparer (other than taxpayer) is based on all information of which he/she has any knowledge. As provided in Chapter 143, RSMo,

a penalty of up to $500 shall be imposed on any individual who files a frivolous return.

Signature

Date (MM/DD/YY)

Spouse’s Signature (if filing combined, BOTH must sign)

Date (MM/DD/YY)

MO-1040, Lines 30Y and 30S ....................................

3S %

MO-NRI Page 2

Use worksheet values in NRI,

Part C, Line 1

Reset

Check boxes to carry amount to MO-1040 with values below

CHECK to fill Line 30Y

CHECK to fill Line 30S

Back to MO-1040, page 3

For Privacy Notice CLICK HERE

Instructions - MO-NRI, Part A

Part A, Line 1: Nonresidents of Missouri

If you are a Missouri nonresident and had Missouri source income, complete Part A, Line 1, Part B, and Part C. Attach a copy of

your federal return and this form to your Missouri return.

Part A, Line 2: Part-Year Resident

If you were a Missouri part-year resident with Missouri source income and income from another state; you may use Form MO-NRI

or Form MO-CR, whichever is to your benefit. When using Form MO-NRI, complete Part A, Line 2, Part B, and Part C. Missouri

source income includes any income (pensions, annuities, etc.) that you received while living in Missouri. Attach a copy of your

federal return and this form to your Missouri return.

Part A, Line 3: Military Nonresident Tax Status

Missouri Home of Record - If you have a Missouri home of record and you:

a) Did not have any Missouri income other than military income, were not in Missouri for more than 30 days, did not maintain a

home in Missouri during the year, but did maintain living quarters elsewhere, you qualify as a nonresident for tax purposes.

Complete Part A, Line 3 and enter “0” on Part C, Line 1.

b) Did have Missouri income other than military income, were in Missouri for more than 30 days or maintained a home in

Missouri during the year, you cannot use this form. You must file Form MO-1040 because 100 percent of your income is

taxable, including your military income. Do not complete this form.

c) Did not have Missouri income other than military income but spent more than 30 days in Missouri or maintained a home in

Missouri during the year, you must file Form MO-1040 because 100 percent of your income is taxable, including your military

income. Do not complete this form.

d) Are married to a Missouri resident, who is not in the military, but lives with you outside of Missouri on military orders, you may

use Form MO-NRI to calculate your Missouri income percentage. However, any income earned by your spouse is taxable to

Missouri. Your spouse is not eligible to complete Form MO-NRI.

Military Nonresident Stationed in Missouri - If you are a military nonresident, stationed in Missouri and you:

a) Earned non-military income while in Missouri - You must file Form MO-1040. Complete Part A, Line 3, Part B and Part C.

The nonresident military pay should be subtracted from your federal adjusted gross income using Form MO-A, Part 1, Line

10, as a “Military (nonresident) Subtraction”.

b) Only had military income while in Missouri - You may complete a Military - No Return Required Form online at

https://sa.dor.mo.gov/nri/.

Note: If you file a joint federal return, you must file a combined Missouri return (regardless of whom earned the income).

Complete each column of Part B and Part C of this form. Do not combine incomes for you and your spouse.

1. Did you maintain a permanent

place of residency in Missouri?

2. Did you spend more than 30

days in Missouri?

You are a

Resident.

Did you maintain a permanent place of

residency elsewhere?

1. Did you maintain a permanent

place of residency in Missouri?

2. Did you spend more than 183

days in Missouri?

Are you domiciled* in Missouri?

YES

both

YES

either

You are a

Nonresident

(for tax

purposes).

You are a Resident.

You are a

Nonresident.

You are a

Resident.

NO to either

YES

both

YES

Use this diagram to determine if you or your spouse are a RESIDENT OR NONRESIDENT

*Domicile (Home of Record) - The place an individual intends to be his or her permanent home; a place that he or she intends to return whenever absent.

A domicile, once established, continues until the individual moves to a new location with the true intention of making his or her permanent home there.

An individual can only have one domicile at a time.

*17000000001*

17000000001

MO-NRI Page 3

For Privacy Notice CLICK HERE

*17317010001*

17317010001

Missouri Department of Revenue

2017 Home Energy Audit Expense

Form

MO-HEA

Street Address

City

AnytaxpayerwhopaidanindividualcertiedbytheDivisionofEnergytocompleteahomeenergyauditmaydeduct100percentofthecosts

incurredfortheauditandtheimplementationofanyenergyefciencyrecommendationsmadebytheauditor.Thesubtractionmaynotexceed

$1,000,forasingletaxpayeror$2,000fortaxpayerslingcombinedreturns.Toqualifyforthesubtraction,youmusthaveincurredexpenses

inthetaxableyearyouarelingaclaim,andtheexpensesincurredmustnothavebeenexcludedfromyourfederaladjustedgrossincomeor

reimbursed through any other state or federal program.

QualificationsInstructions

In the spaces provided below:

• Report the name of the auditor who conducted the audit

•Reporttheauditor’scerticationnumber

• Summarize each of the auditor’s recommendations

• Enter the amount paid for the audit on Line A

• Enter the total amount paid to implement the energy

efciencyrecommendationsonLineB

• Enter the total amount paid for the audit and any

implemented recommendations on Line C

• Attach applicable receipts

• Attach completed MO-HEA and receipts

to Form MO-1040

Auditor Summary

Auditor Name Auditor Certification Number

Summary of Recommendations

Form MO-HEA (Revised 12-2017)Taxation Division

A. Amount paid for audit ..............................................................

B. Amount paid to implement recommendations ...........................................

C. Total Paid - Add Lines A and B and enter here ..........................................

D. Enter$1,000ifasingleleror$2,000iflingacombinedreturn ............................

E. Amount from Line C or Line D, whichever is less. Enter here and on Form MO-A, Line 14. If you are

 lingacombinedreturn,youmaysplittheamountreportedonLine14betweenbothspouses.....

Department Use Only

(MM/DD/YY)

Social Security Number

Taxpayer Name

- -

State ZIP Code

Spouse’s Social Security Number

Spouse’s Name

- -

Yourself

Spouse

Back to MO-A Part 2

For Privacy Notice CLICK HERE

Missouri Tax

I.D. Number

Federal Employer

I.D. Number

• Benefit Number - The number is the last six (6) digits of the number located on your Certificate of Eligibility.

Example: For benefit, ABC-2018-12345-123456, enter 123456, on Form MO-TC.

• Alpha code - The three (3) character code located on the back of this form. Each credit is assigned an alpha code to ensure proper processing of

the credit claimed.

• If you are claiming more than 10 credits, attach additional MO-TC(s).

Form MO-TC (Revised 08-2018)

Form

MO-TC

Missouri Department of Revenue

2017 Miscellaneous Income Tax Credits

Social Security

Number

Name

(Last, First)

Spouse’s Social

Security Number

Spouse’s Name

(Last, First)

Use Column 1 if you are filing:

• An individual income tax return with a single type filing status;

• A fiduciary return; or,

• A corporation income tax return.

I declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax

exemption, credit or abatement if I employ such aliens. I also declare that if I am a business entity, I participate in a federal work authorization program

with respect to the employees working in connection with any contracted services and I do not knowingly employ any person who is an unauthorized

alien in connection with any contracted services.

Instructions

*17306010001*

17306010001

Use this form to claim income tax credits on Form MO-1040, MO-1120,

or MO-1041. Attach to Form MO-1040, MO-1120, or MO-1041.

Charter

Number

Corporation

Name

Department Use Only

(MM/DD/YY)

1. 1. 00 00

2. 2. 00 00

3. 3. 00 00

4. 4. 00 00

5. 5. 00 00

6. 6. 00 00

7. 7. 00 00

8. 8. 00 00

9. 9. 00 00

10. 10. 00 00

11. Subtotals - add Lines 1 through 10. ......................................................... 11. 00 00

12. Enter the amount of the tax liability from Form MO-1040, Line 33Y for yourself and Line 33S for your spouse,

or Form MO-1120, Line 15 plus Line 16 for income from or Form MO-1041, Line 18.

.....................

12. 00 00

13. Total Credits - add amounts from Line 11, Columns 1 and 2. (Enter here and on Form MO-1120, Line 18; Form MO-1040,

Line 40; or Form MO-1041, Line 19.) Line 13 cannot exceed the amount on Line 12, unless the credit is refundable. ........

13. 00

• Yourself

• Corporation Income

• Fiduciary

• Spouse

(on a combined return)

Column 1 Column 2

Alpha Code

(3 characters)

from back

Benet Number

(See example above)

Credit Name

Each credit will apply against your tax

liability in the order they appear below

If you are a shareholder or partner claiming a credit, attach a copy of the shareholder listing or Federal Schedule K-1, specifying your percentage and the

corporation’s percentage of ownership.

If you are filing a combined return and both you and your spouse have income:

• Use Column 1 for yourself and Column 2 for spouse.

• Both names must be on the credit certificate.

For Privacy Notice, see instructions

For Privacy Notice CLICK HERE

Missouri Tax

I.D. Number

Federal Employer

I.D. Number

• Benefit Number - The number is the last six (6) digits of the number located on your Certificate of Eligibility.

Example: For benefit, ABC-2018-12345-123456, enter 123456, on Form MO-TC.

• Alpha code - The three (3) character code located on the back of this form. Each credit is assigned an alpha code to ensure proper processing of

the credit claimed.

• If you are claiming more than 10 credits, attach additional MO-TC(s).

Form MO-TC (Revised 08-2018)

Form

MO-TC

Missouri Department of Revenue

2017 Miscellaneous Income Tax Credits

Social Security

Number

Name

(Last, First)

Spouse’s Social

Security Number

Spouse’s Name

(Last, First)

Use Column 1 if you are filing:

• An individual income tax return with a single type filing status;

• A fiduciary return; or,

• A corporation income tax return.

I declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax

exemption, credit or abatement if I employ such aliens. I also declare that if I am a business entity, I participate in a federal work authorization program

with respect to the employees working in connection with any contracted services and I do not knowingly employ any person who is an unauthorized

alien in connection with any contracted services.

Instructions

*17306010001*

17306010001

Use this form to claim income tax credits on Form MO-1040, MO-1120,

or MO-1041. Attach to Form MO-1040, MO-1120, or MO-1041.

Charter

Number

Corporation

Name

Department Use Only

(MM/DD/YY)

1. 1. 00 00

2. 2. 00 00

3. 3. 00 00

4. 4. 00 00

5. 5. 00 00

6. 6. 00 00

7. 7. 00 00

8. 8. 00 00

9. 9. 00 00

10. 10. 00 00

11. Subtotals - add Lines 1 through 10. ......................................................... 11. 00 00

12. Enter the amount of the tax liability from Form MO-1040, Line 33Y for yourself and Line 33S for your spouse,

or Form MO-1120, Line 15 plus Line 16 for income from or Form MO-1041, Line 18.

.....................

12. 00 00

13. Total Credits - add amounts from Line 11, Columns 1 and 2. (Enter here and on Form MO-1120, Line 18; Form MO-1040,

Line 40; or Form MO-1041, Line 19.) Line 13 cannot exceed the amount on Line 12, unless the credit is refundable. ........

13. 00

• Yourself

• Corporation Income

• Fiduciary

• Spouse

(on a combined return)

Column 1 Column 2

Alpha Code

(3 characters)

from back

Benet Number

(See example above)

Credit Name

Each credit will apply against your tax

liability in the order they appear below

If you are a shareholder or partner claiming a credit, attach a copy of the shareholder listing or Federal Schedule K-1, specifying your percentage and the

corporation’s percentage of ownership.

If you are filing a combined return and both you and your spouse have income:

• Use Column 1 for yourself and Column 2 for spouse.

• Both names must be on the credit certificate.

For Privacy Notice, see instructions

Back to MO-1040, page 4

For Privacy Notice CLICK HERE

* Must be approved by the issuing agency

Individuals with speech or hearing impairments may call TTY (800) 735-2966 or fax (573) 526-1881.

Miscellaneous tax credits are administered by various agencies. For more information, forms, and approval to claim these credits,

contact the following Departments. Visit http://dor.mo.gov/taxcredit/ for a description of each credit and more contact information for

agencies administering each credit.

P.O. Box 2200, Jefferson City, MO 65105-2200

http://dor.mo.gov/ • (573) 751-3220 or (573) 751-4541

Alpha Attach to

Code Name of Credit Form MO-TC

ATC Special Needs Adoption Form ATC, and

Federal Form 8839

BFT Bank Franchise Tax Form INT-2, INT-2-1

BTC Bank Tax Credit for S Corporation Form BTC, and Form

Shareholders INT-3,

2823, INT-2, Fed. K-1

CIC Children in Crisis Contribution

Verification from

Issuing Agency

CFC Champion for Children Contribution

Verification from

Issuing Agency

DAC Disabled Access Federal Form 8826

and Form MO-8826

DAT Residential Dwelling Accessibility Form MO-DAT

FPT Food Pantry Tax Form MO-FPT

SHC Self-Employed Health Insurance Form MO-SHC

SSC Public Safety Officer Surviving Spouse Form MO-SSC

Missouri Agricultural and Small

Business Development Authority

P.O. Box 630, Jefferson City, MO 65102-0630

http://www.agriculture.mo.gov • (573) 751-2129

Alpha Attach to

Code Name of Credit Form MO-TC

APU Agricultural Product Utilization Contributor Certificate*

FFC Family Farms Act Certificate*

MPF Meat Processing Facility Investment Tax Credit Certificate*

NGC New Generation Cooperative Incentive Certificate*

QBC Qualified Beef Certificate*

Missouri Department of Natural Resources

Jefferson City, MO 65105

http://www.dnr.mo.gov

Alpha Attach to

Code Name of Credit and Phone Number Form MO-TC

CPC Charcoal Producers - (573) 751-4817 Certificate*

Missouri Department of Social Services

Jefferson City, MO 65109

http://www.dss.mo.gov/dfas/taxcredit/index.htm • (573) 751-7533

Alpha Attach to

Code Name of Credit Form MO-TC

DDC Developmental Disability Care Provider Certificate*

DVC Shelter for Victims of Domestic Violence Certificate*

MHC Maternity Home Certificate*

PRC Pregnancy Resource Certificate*

RTA Residential Treatment Agency Certificate*

Missouri Department of Health

Division of Senior Services

P.O. Box 570, Jefferson City, MO 65102-0570

http://www.dhss.mo.gov

Alpha Attach to

Code Name of Credit and Phone Number Form MO-TC

SCT Shared Care - (573) 751-4842 Must Register Each

Year With Division of

Senior and Disability

Services

- Attach

Form MO-SCC

P.O. Box 118, Jefferson City, MO 65102-0118

http://www.ded.mo.gov

Alpha Attach to

Code Name of Credit and Phone Number Form MO-TC

AFI Alternative Fuel Infrastructure - (573) 751-2254 Certificate*

BFC New or Expanded Business Facility - (573) 526-5417 Schedule 150,

Fed. K-1, Form 4354

BJI Brownfield “Jobs and Investment” - (573) 522-8004 Certificate*

DAL Distressed Area Land Assemblage - (573) 522-8004 Certificate*

DFH Dry Fire Hydrant - (573) 751-9048 Certificate*

DPC Development Tax Credit - (573) 526-3285 Certificate*

EZC Enterprise Zone - (573) 522-2790 Schedule 250,

Fed. K-1, Form 4354

FDA Family Development Account - (573) 751-4539 Certificate*

FPC Film Production - (573) 751-9048 Certificate*

HPC Historic Preservation - (573) 522-8004 Certificate*

ISB Small Business Investment (Capital) - (573) 526-5417 Certificate*

ICT Innovation Campus Tax Credit - (573) 751-4539 Certificate*

MQJ Missouri Quality Jobs - (573) 751-4539 Certificate*

MWC Missouri Works Credit - (573) 522-9062 Certificate*

NAC Neighborhood Assistance - (573) 522-2629 Certificate*

NEC New Enterprise Creation - (573) 522-2790 Certificate*

NEZ New Enhanced Enterprise Zone - (573) 751-4539 Certificate*

NMC New Market Tax Credit - (573) 522-8004 Certificate*

RCC Rebuilding Communities - (573) 526-3285 Certificate*

RCN Rebuilding Communities and Neighborhood

Preservation Act - (573) 522-8004 Certificate*

REC Qualified Research Expense - (573) 526-0124 Certificate*

RTC Remediation - (573) 522-8004 Certificate*

SBG Small Business Guaranty Fees - (573) 751-9048 Certificate*

SBI Small Business Incubator - (573) 751-4539 Certificate*

SEC Sporting Event Credit - (573) 522-8006 Certificate*

SPC Sporting Contribution Credit - (573) 522-8006 Certificate*

TDC Transportation Development - (573) 751-4539 Certificate*

WEC Processed Wood Energy - (573) 526-1723 Certificate*

WGC Wine and Grape Production - (573) 751-9048 Certificate*

YOC Youth Opportunities - (573) 751-4539 Certificate*

Missouri Development Finance Board

P.O. Box 567, Jefferson City, MO 65102-0567

http://www.mdfb.org • (573) 751-8479

Alpha Attach to

Code Name of Credit Form MO-TC

BEC Bond Enhancement Certificate*

BUC Missouri Business Use Incentives for Large Certificate*

Scale Development (BUILD)

DRC Development Reserve Contribution Credit Certificate*

EFC Export Finance Certificate*

IDC Infrastructure Development Certificate*

Missouri Housing Development Commission

920 Main Street, Suite 1400, Kansas City, MO 64105

http://www.mhdc.com

Alpha Attach to

Code Name of Credit and Phone Number Form MO-TC

AHC Affordable Housing Assistance - (816) 759-6878 Certificate*

LHC Missouri Low Income Housing - (816) 759-6878 Eligibility Statement,

Fed. K-1, 8609A,

8609 (first year)

Missouri Department of Economic Development

Missouri Department of Revenue

Form MO-TC (Revised 08-2018)

*17000000001*

17000000001

For Privacy Notice CLICK HERE

1. Wages, salaries, tips, etc.......................... 1 7 7 00 1 00

2. Taxable interest income.......................... 2 8a 8a 00 2 00

3. Dividend income............................... none 9a 9a 00 3 00

4. State and local income tax refunds ................. none none 10 00 4 00

5. Alimony received .............................. none none 11 00 5 00

6. Business income or (loss)......................... none none 12 00 6 00

7. Capital gain or (loss) ............................ none 10 13 00 7 00

8. Other gains or (losses) ........................... none none 14 00 8 00

9. Taxable IRA distributions......................... none 11b 15b 00 9 00

10. Taxable pensions and annuities .................... none 12b 16b 00 10 00

11. Rents, royalties, partnerships, S corporations, trusts, etc..... none none 17 00 11 00

12. Farm income or (loss) ........................... none none 18 00 12 00

13. Unemployment compensation..................... 3 13 19 00 13 00

14. Taxable social security benefits .................... none 14b 20b 00 14 00

15. Other income ................................. none none 21 00 15 00

16. Total (add Lines 1 through 15) ..................... 4 15 22 00 16 00

17. Less: federal adjustments to income................. none 20 36 00 17 00

18. Federal adjusted gross income (Line 16 less Line 17)

Enter amounts here and on Lines 1Y and 1S, Form MO-1040. 4 21 37 00 18 00

Adjusted Gross Income Worksheet for Combined Return

Federal Form

1040EZ Line No.

Federal Form

1040A Line No.

Federal Form

1040 Line No.

Y - Yourself

S - Spouse

Missouri law requires a combined return for married couples filing together. A combined return means taxpayers are required to split their total federal adjusted gross income

(including other state income) between spouses when beginning the Missouri return.

Splitting the income can be as easy as adding up your separate Forms W-2 and 1099. Or it may require allocating to each spouse the percentage of ownership in jointly

held property, such as businesses, farm operations, dividends, interest, rent, and capital gains or losses. State refunds should be split based on each spouse’s 2016 Missouri

tax withheld, less each spouse’s 2016 tax liability. The result should be each spouse’s portion of the 2016 refund. Taxable social security benefits must be allocated by each

spouse’s share of the benefits received for the year.

The worksheet below lists income that is included on your federal return, along with federal line references. Find the lines that apply to your federal return, split the income between

you and your spouse, and enter the amounts on the worksheet. When you have completed the worksheet, transfer the amounts from Line 18 to Form MO-1040, Lines 1Y and 1S.

Note: Remember, the incomes listed separately on Line 18 of this worksheet must equal your total federal adjusted gross income when added together.

Worksheet for Line 1 - Instructions for Completing the Adjusted Gross Income Worksheet

Carry amounts to MO-1040, Line 1Y and 1S.

Back to MO-1040, page 2

This form must be attached to Form MO-1040 or MO-1040P.

*17323010001*

17323010001

Missouri Department of Revenue

2017 Property Tax Credit Schedule

Department Use Only

(MM/DD/YY)

Social Security Number

Spouse’s Social Security Number

Form

MO-PTS

Date of Birth (MM/DD/YYYY)

Spouse’s Date of Birth (MM/DD/YYYY)

Select only one qualification. Copies of letters, forms, etc., must be included with claim.

A. 65 years of age or older - You must be a full year resident. (Attach Form SSA-1099.)

B. 100% Disabled Veteran as a result of military service (Attach letter from Department of Veterans Affairs - see instructions.)

C. 100% Disabled (Attach letter from Social Security Administration or Form SSA-1099.)

D. 60 years of age or older and received surviving spouse benefits (Attach Form SSA-1099.)

Qualifications

Select only one filing status. If married filing combined, you must report both incomes.

1. Enter the amount of income from Form MO-1040, Line 6 or Form MO-1040P, Line 4.........

2. Enter the amount of nontaxable social security benefits received by you, your spouse, and your

minor children before any deductions and the amount of social security equivalent railroad

retirement benefits. Attach Form(s) SSA-1099 or RRB-1099 (TIER I) .....................

3. Enter the total amount of pensions, annuities, dividends, rental income, or interest income not

included in Line 1. Include tax exempt interest from MO-A, Part 1, Line 8 (if filing Form

4. Enter the amount of railroad retirement benefits (not included in Line 2) before any deductions.

Attach Form RRB-1099-R (Tier II). If filing Form MO-1040, refer to MO-A, Part 1, Line 10 . . . . .

Attach letter from Veterans Affairs (see instructions) ..................................

Filing

Status

MO-1040). Attach Forms W-2, 1099, 1099-R, 1099-MISC, 1099-INT, 1099-DIV, etc .........

Income

5. Enter the amount of veterans payments or benefits before any deductions.

Single Married - Filing Combined Married - Living Separate for Entire Year

M.I. Last NameFirst Name

M.I. Last NameSpouse’s First Name

- -

For Privacy Notice, see Instructions.

Failure to provide the following attachments will result in denial or delay of your claim:

rent receipt(s), Verification of Rent Paid (Form 5674) or a signed landlord statement, Form(s) 1099, W-2, etc.

MO-PTS Page 1

Line 2

Line 3

Line 4

Line 5

For Privacy Notice CLICK HERE

*17323020001*

17323020001

9. Enter the appropriate amount from the options below ..................................

10. Net household income - Subtract Line 9 from Line 8 and enter the amount here .............

• If you rented or did not own and occupy your home for the entire year and Line 10 is

greater than $27,500, you are not eligible to file this claim.

• If you owned and occupied your home for the entire year and Line 10 is greater

than $30,000, you are not eligible to file this claim.

11. If you owned your home, enter the total amount of property tax paid for your home, less

special assessments, or $1,100, whichever is less. Attach a copy of paid real estate tax

receipt(s). If your home is on more than five acres or you own a mobile home, attach the

12. If you rented, enter the total amount from Certification of Rent Paid (Form(s) MO-CRP), Line 9

or $750, whichever is less. Attach rent receipts or a signed statement from your landlord.

Note: If you rent from a facility that does not pay property tax, you are not eligible for a

13. Enter the total of Lines 11 and 12, or $1,100, whichever is less ..........................

14. Apply Lines 10 and 13 to the chart in the instructions for MO-1040, pages 49-51 or MO-1040P,

pages 29-31 to figure your Property Tax Credit. You must use the chart to see how much credit

you are allowed. Enter this amount on Form MO-1040, Line 41 or Form MO-1040P, Line 20 .....

This form must be attached to Form MO-1040 or Form MO-1040P.

Income (continued)Real Estate or RentCredit

8. Total household income - Add Lines 1 through 7 and enter the total here .................

Assessor’s Certification (Form 948) ...............................................

7. Enter the amount of nonbusiness loss(es). You must include nonbusiness loss(es) in your

household income (as a positive amount) here. (Include capital loss from Federal Form 1040,

. Line 13.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Enter the total amount received by you, your spouse, and your minor children from: public

assistance, SSI, child support, or Temporary Assistance payments (TA and TANF). Attach a

letter from the Social Security Administration that includes the total amount of assistance

received and Form 1099 from Employment Security, if applicable ........................

• Single or Married Living Separate - Enter $0

• Married and Filing Combined - rented or did not own your home for the entire year - Enter $2,000

• Married and Filing Combined - owned and occupied your home for the entire year - Enter $4,000

K RA U

Department Use Only

Property Tax Credit ............................................................

MO-PTS Page 2 (Revised 12-2017)

Line 6

Line 7

Line 9

Check if you owned and occupied

your home for the entire year

Line 10

Line 11

Go to MO-CRP

Line 12

Line 13

Line 14

Back to MO-1040, page 4

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Certification of Rent Paid

Form

MO-CRP

1. Social Security Number

Form MO-CRP (Revised 12-2017)

*17315010001*

17315010001

Spouse’s Social Security Number

5. Rental Period During Year

From:

(MM/DD/YY)

To:

(MM/DD/YY)

8. Net rent paid - Multiply Line 6 by the percentage on Line 7............................................

9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS

.......

For Privacy Notice, see instructions.

Taxation Division

Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.

7. Select the appropriate box below and enter the corresponding percentage on Line 7 ........................

A. Apartment, House, Mobile Home, or Duplex - 100% F. Low Income Housing - 100% (Rent cannot exceed 40% of total

B. Mobile Home Lot - 100%

C. Boarding Home or Residential Care - 50%

Shared Residence – If you shared your rent with relatives or friends

D. Skilled or Intermediate Care Nursing Home - 45%

E. Hotel - 100%; if meals are included - 50%

Select this box if related to your landlord. If so, explain.

2. Name (First, Last)

Physical Address of Rental Unit (P.O. Box Not Allowed) Apartment Number

3. Landlord’s Name (First, Last)

Landlord’s Street Address (Must be completed)

4. Landlord’s Phone Number (Must be completed)

City State ZIP Code

1 (50%) 2 (33%) 3

(25%)

Landlord’s Last 4 Digits of Social Security Number

One Form MO-CRP must be provided for each rental location in which you resided.

Failure to provide landlord information will result in denial or delay of your claim.

household income.)

(other than your spouse or children under 18), select the appropriate

box based on the additional persons sharing rent:

City State ZIP Code

- -- -

Apartment Number

the amount of rent you paid. Note: If you rent from a facility that does not pay property tax, you are not

from your landlord, or copies of canceled checks (front and back). If you received housing assistance, enter

6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement

eligible for a Property Tax Credit ..............................................................

Landlord’s Federal Employee Identification Number (FEIN) - if applicable

Line 1

2017

Line 6

Line 7

Line 8

Line 9

Back to MO-PTS

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Certification of Rent Paid

Form

MO-CRP

1. Social Security Number

Form MO-CRP (Revised 12-2017)

*17315010001*

17315010001

Spouse’s Social Security Number

5. Rental Period During Year

From:

(MM/DD/YY)

To:

(MM/DD/YY)

8. Net rent paid - Multiply Line 6 by the percentage on Line 7............................................

9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS

.......

For Privacy Notice, see instructions.

Taxation Division

Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.

7. Select the appropriate box below and enter the corresponding percentage on Line 7 ........................

A. Apartment, House, Mobile Home, or Duplex - 100% F. Low Income Housing - 100% (Rent cannot exceed 40% of total

B. Mobile Home Lot - 100%

C. Boarding Home or Residential Care - 50%

Shared Residence – If you shared your rent with relatives or friends

D. Skilled or Intermediate Care Nursing Home - 45%

E. Hotel - 100%; if meals are included - 50%

Select this box if related to your landlord. If so, explain.

2. Name (First, Last)

Physical Address of Rental Unit (P.O. Box Not Allowed) Apartment Number

3. Landlord’s Name (First, Last)

Landlord’s Street Address (Must be completed)

4. Landlord’s Phone Number (Must be completed)

City State ZIP Code

1 (50%) 2 (33%) 3

(25%)

Landlord’s Last 4 Digits of Social Security Number

One Form MO-CRP must be provided for each rental location in which you resided.

Failure to provide landlord information will result in denial or delay of your claim.

household income.)

(other than your spouse or children under 18), select the appropriate

box based on the additional persons sharing rent:

City State ZIP Code

- -- -

Apartment Number

the amount of rent you paid. Note: If you rent from a facility that does not pay property tax, you are not

from your landlord, or copies of canceled checks (front and back). If you received housing assistance, enter

6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement

eligible for a Property Tax Credit ..............................................................

Landlord’s Federal Employee Identification Number (FEIN) - if applicable

Line 1

2017

Line 6

Line 7

Line 8

Line 9

Back to MO-PTS

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Certification of Rent Paid

Form

MO-CRP

1. Social Security Number

Form MO-CRP (Revised 12-2017)

*17315010001*

17315010001

Spouse’s Social Security Number

5. Rental Period During Year

From:

(MM/DD/YY)

To:

(MM/DD/YY)

8. Net rent paid - Multiply Line 6 by the percentage on Line 7............................................

9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS

.......

For Privacy Notice, see instructions.

Taxation Division

Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.

7. Select the appropriate box below and enter the corresponding percentage on Line 7 ........................

A. Apartment, House, Mobile Home, or Duplex - 100% F. Low Income Housing - 100% (Rent cannot exceed 40% of total

B. Mobile Home Lot - 100%

C. Boarding Home or Residential Care - 50%

Shared Residence – If you shared your rent with relatives or friends

D. Skilled or Intermediate Care Nursing Home - 45%

E. Hotel - 100%; if meals are included - 50%

Select this box if related to your landlord. If so, explain.

2. Name (First, Last)

Physical Address of Rental Unit (P.O. Box Not Allowed) Apartment Number

3. Landlord’s Name (First, Last)

Landlord’s Street Address (Must be completed)

4. Landlord’s Phone Number (Must be completed)

City State ZIP Code

1 (50%) 2 (33%) 3

(25%)

Landlord’s Last 4 Digits of Social Security Number

One Form MO-CRP must be provided for each rental location in which you resided.

Failure to provide landlord information will result in denial or delay of your claim.

household income.)

(other than your spouse or children under 18), select the appropriate

box based on the additional persons sharing rent:

City State ZIP Code

- -- -

Apartment Number

the amount of rent you paid. Note: If you rent from a facility that does not pay property tax, you are not

from your landlord, or copies of canceled checks (front and back). If you received housing assistance, enter

6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement

eligible for a Property Tax Credit ..............................................................

Landlord’s Federal Employee Identification Number (FEIN) - if applicable

Line 1

2017

Line 6

Line 7

Line 8

Line 9

Back to MO-PTS

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Certification of Rent Paid

Form

MO-CRP

1. Social Security Number

Form MO-CRP (Revised 12-2017)

*17315010001*

17315010001

Spouse’s Social Security Number

5. Rental Period During Year

From:

(MM/DD/YY)

To:

(MM/DD/YY)

8. Net rent paid - Multiply Line 6 by the percentage on Line 7............................................

9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS

.......

For Privacy Notice, see instructions.

Taxation Division

Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.

7. Select the appropriate box below and enter the corresponding percentage on Line 7 ........................

A. Apartment, House, Mobile Home, or Duplex - 100% F. Low Income Housing - 100% (Rent cannot exceed 40% of total

B. Mobile Home Lot - 100%

C. Boarding Home or Residential Care - 50%

Shared Residence – If you shared your rent with relatives or friends

D. Skilled or Intermediate Care Nursing Home - 45%

E. Hotel - 100%; if meals are included - 50%

Select this box if related to your landlord. If so, explain.

2. Name (First, Last)

Physical Address of Rental Unit (P.O. Box Not Allowed) Apartment Number

3. Landlord’s Name (First, Last)

Landlord’s Street Address (Must be completed)

4. Landlord’s Phone Number (Must be completed)

City State ZIP Code

1 (50%) 2 (33%) 3

(25%)

Landlord’s Last 4 Digits of Social Security Number

One Form MO-CRP must be provided for each rental location in which you resided.

Failure to provide landlord information will result in denial or delay of your claim.

household income.)

(other than your spouse or children under 18), select the appropriate

box based on the additional persons sharing rent:

City State ZIP Code

- -- -

Apartment Number

the amount of rent you paid. Note: If you rent from a facility that does not pay property tax, you are not

from your landlord, or copies of canceled checks (front and back). If you received housing assistance, enter

6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement

eligible for a Property Tax Credit ..............................................................

Landlord’s Federal Employee Identification Number (FEIN) - if applicable

Line 1

2017

Line 6

Line 7

Line 8

Line 9

Back to MO-PTS

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 Certification of Rent Paid

Form

MO-CRP

1. Social Security Number

Form MO-CRP (Revised 12-2017)

*17315010001*

17315010001

Spouse’s Social Security Number

5. Rental Period During Year

From:

(MM/DD/YY)

To:

(MM/DD/YY)

8. Net rent paid - Multiply Line 6 by the percentage on Line 7............................................

9. Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS

.......

For Privacy Notice, see instructions.

Taxation Division

Attach to Form MO-PTC or MO-PTS and mail to the Missouri Department of Revenue.

7. Select the appropriate box below and enter the corresponding percentage on Line 7 ........................

A. Apartment, House, Mobile Home, or Duplex - 100% F. Low Income Housing - 100% (Rent cannot exceed 40% of total

B. Mobile Home Lot - 100%

C. Boarding Home or Residential Care - 50%

Shared Residence – If you shared your rent with relatives or friends

D. Skilled or Intermediate Care Nursing Home - 45%

E. Hotel - 100%; if meals are included - 50%

Select this box if related to your landlord. If so, explain.

2. Name (First, Last)

Physical Address of Rental Unit (P.O. Box Not Allowed) Apartment Number

3. Landlord’s Name (First, Last)

Landlord’s Street Address (Must be completed)

4. Landlord’s Phone Number (Must be completed)

City State ZIP Code

1 (50%) 2 (33%) 3

(25%)

Landlord’s Last 4 Digits of Social Security Number

One Form MO-CRP must be provided for each rental location in which you resided.

Failure to provide landlord information will result in denial or delay of your claim.

household income.)

(other than your spouse or children under 18), select the appropriate

box based on the additional persons sharing rent:

City State ZIP Code

- -- -

Apartment Number

the amount of rent you paid. Note: If you rent from a facility that does not pay property tax, you are not

from your landlord, or copies of canceled checks (front and back). If you received housing assistance, enter

6. Enter your gross rent paid. Attach rent receipt(s) for each rent payment for the entire year, a signed statement

eligible for a Property Tax Credit ..............................................................

Landlord’s Federal Employee Identification Number (FEIN) - if applicable

Line 1

2017

Line 6

Line 7

Line 8

Line 9

Back to MO-PTS

For Privacy Notice CLICK HERE

A. Enter the amount paid for qualified long-term care insurance policy. ........................ A) $ __________________

If you itemized on your federal return and your federal itemized

deductions included medical expenses, go to Line B. If not, skip to H.

B. Enter the amount from Federal Schedule A, Line 4 ...................................... B) $ __________________

C. Enter the amount from Federal Schedule A, Line 1. ...................................... C) $ __________________

D. Enter the amount of qualified long-term care included on Line C ........................... D) $ __________________

E. Subtract Line D from Line C ....................................................... E) $ __________________

F. Subtract Line E from Line B. If amount is less than zero, enter “0”. ......................... F) $ __________________

G. Subtract Line F from Line A ........................................................ G) $ __________________

H. Enter Line G (or Line A if you did not have to complete Lines B through G) on Form MO-1040, Line 18.

Attach a copy of your Federal Form 1040 (pages 1 and 2) and Federal Schedule A (if you itemized your deductions).

Worksheet for Long-Term Care Insurance Deduction

Missouri Department of Revenue

Qualified Health Insurance Premiums

Worksheet for MO-A, Line 12

Form

5695

Yourself (Y) Spouse (S)

1. Enter the amount from Federal Form 1040A, Line 14a, or Federal Form 1040, Line 20a. If $0, skip to

Line 6 and enter your total health insurance premiums paid ........................................

Complete this worksheet and attach it, along with proof of premiums paid, to Form MO-1040 if you included health insurance premiums paid as an

itemized deduction or had health insurance premiums withheld from your social security benefits.

If you had premiums withheld from your social security benefits, complete Lines 1 through 4 to determine your taxable percentage of social security

2. Enter amount from Federal Form 1040A, Line 14b or Federal Form 1040, Line 20b .....................

3. Divide Line 2 by Line 1 .....................................................................

4. Enter the health insurance premiums withheld from your social

security income .............................................

5. Multiply the amounts on Line 4Y and 4S by the percentage on Line 3. ...

6. Enter the total of all other health insurance premiums paid, which

were not included on 4Y or 4S ..................................

7. Add the amounts from Lines 5 and 6 .............................

8. Add the amounts from Lines 7Y and 7S .......................................................

9. Divide Line 7Y and 7S by the total found on Line 8. If you itemized

9S9Y

on your federal return and your federal itemized deductions included

health insurance premiums as medical expenses, go to Line 10.

If not, go to Line 15 ...........................................

10. Enter the amount from Federal Schedule A, Line 1 ...............................................

11. Enter the amount from Federal Schedule A, Line 4................................................

12. Divide Line 11 by Line 10 (round to full percent) .................................................

12 %

13. Multiply Line 8 by percent on Line 12 ..........................................................

14. Subtract Line 13 from Line 8.................................................................

15. Enter your federal taxable income from Federal Form 1040A, Line 27, or Federal Form 1040, Line 43 .......

16. If you itemized on your federal return and completed Lines 10 through 14 above, enter the amount from

Line 14 or Line 15, whichever is less. If not, enter the amount from Line 8 or Line 15, whichever is less ......

17. Multiply Line 16 by the percentage on Line 9Y and Line 9S.

Enter the amounts on Line 17Y and 17S of this worksheet on Line 12

Form 5695 (Revised 12-2017)

income and the corresponding taxable portion of your health insurance premiums included in your taxable income.

*17351010001*

17351010001

of Form MO-A ...............................................

17S

17Y

Social Security Number

- -

Spouse’s Social Security Number

- -

Back to MO-A, Line 12

For Privacy Notice CLICK HERE

Missouri Department of Revenue

2017 MOST - Missouri’s 529 College Savings Plan

Direct Deposit Form - Individual Income Tax

Form

5632

Taxpayer

*17348010001*

17348010001

MOST-Missouri’s 529 College Savings Plan

Form 5632 (Revised 12-2017)

If you wish to deposit all or a portion of your refund into a Missouri MOST 529 College Savings Plan, you must include this form with your

Taxation Division

Add the amounts from Line A through Line D and enter the total deposit amount here

Requirements

If you want to deposit your refund as a contribution to one or more Missouri MOST 529 College Savings Plan accounts:

• You must have an open Missouri MOST 529 College Savings Plan account that is administered by the Missouri Higher

Education Savings Program. See the contact information below.

• Your total deposit must be at least $25.

• If your overpayment is adjusted and the amount you requested to deposit exceeds your available refund, the Department will

• If your refund is offset to pay another debt, the Department will cancel your deposit.

cancel your deposit and issue a refund to you.

Enter the 11-digit MOST 529 account number and the amount you want contributed to each account. (You may contribute to a

maximum of four accounts.)

529 Account

A) Account Number

B) Account Number

C) Account Number

D) Account Number

Total Deposit

and on Form MO-1040, Line 49; Form MO-1040A, Line 19; or Form MO-1040P, Line 25.

Contact Information

A) Amount

B) Amount

C) Amount

D) Amount

Missouri Individual Income Tax Return.

E-mail: most529@missourimost.org

Telephone: (888) 414-6678

https://www.missourimost.org

M.I.

Last Name

First Name Suffix

Spouse’s Last NameSpouse’s First Name

M.I.

Suffix

Social Security Number Spouse’s Social Security Number

- - - -

Department Use Only

(MM/DD/YY)

Back to MO-1040, page 4

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Completed 28 December 2023

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