Michigan Department of Treasury (Rev. 05-16), Page 1 of 3
Issued under authority of Public Act 281 of 1967, as amended.
2016 MICHIGAN Homestead Property Tax Credit Claim MI-1040CR
Type or print in blue or black ink. Print numbers like this: 0123456789 - NOT like this: 1 4
Attachment 05
1. Filer’s First Name M.I. Last Name
2. Filer’s Full Social Security No. (Example: 123-45-6789)
If a Joint Return, Spouse’s First Name M.I. Last Name
3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street, P.O. Box). If using a P.O. Box, you must complete line 45.
City or Town State ZIP Code 4. School District Code (5 digits - see page 60)
5. Check the box(es) for which you or your spouse qualify (excluding dependents). If you qualify for both, see instructions.
a.
Age 65 or older; or an unremarried spouse of a person
b.
Deaf, blind, hemiplegic, paraplegic, quadriplegic, or
who was 65 or older at the time of death. totally and permanently disabled.
6. 2016 FILING STATUS:
*If you checked box “c,” enter dates of Michigan residency in 2016.
Check one.
a. Single a. Resident FILER SPOUSE
FROM:
b. Married ling jointly b. Nonresident
2016 2016
TO:
2016 2016
c. Married ling separately c. Part-Year Resident *
(Attach Form 5049)
8. Homestead Status
Check here if the taxable value of your homestead includes unoccupied farmland classied as agricultural by your assessor.
9.
Homeowners: Enter the 2016 taxable value of your homestead (see instructions). If you did not
check box 8 above and your taxable value is greater than $135,000, STOP; you are not eligible.
Farmers: enter the taxable value of your homestead, including eligible unoccupied farmland
............. 9. 00
10. Property Taxes levied on your home for 2016 (see instructions) or amount from line 51, 56 and/or 57 10. 00
11. Renters: Enter rent you paid for 2016 from line 53 and/or 55 ............... 11.
00
12. Multiply
line 11 by 20% (0.20)
................................................................................................................ 12. 00
13. Total. Add lines 10 and 12
.................................................................................................................... 13. 00
TOTAL HOUSEHOLD RESOURCES. If ling a joint return, include income from both spouses.
If married ling separately, you must attach Form 5049 available on Treasury’s Web site.
14.
Wages, salaries, tips, sick, strike
21.
Social Security, SSI, and/or
and SUB pay, etc.
......................... 14.
00
railroad retirement benets.
.. 21.
00
15.
All interest and dividend income
22.
Child support and foster
(including nontaxable interest)...... 15.
00
parent payments.
.................. 22.
00
16.
Net business income (including net
23.
Unemployment
farm income). If negative enter “0” 16.
00
compensation.
...................... 23.
00
17.
Net royalty or rent income.
24.
Gifts or expenses paid on
If negative enter “0”.
..................... 17.
00
your behalf.
........................... 24.
00
18.
Retirement pension, annuity, and
25.
Other nontaxable income
IRA benets.
................................. 18.
00
Describe:
_______________ 25.
00
19.
26.
Workers’/veterans’ disability
(see instructions).
......................... 19.
26.
Capital gains less capital losses,
00
compensation/pension benets
00
20.
Alimony and other taxable income
27.
FIP and other MDHHS benets
Describe:
___________________ 20.
00
(Do not include food assistance) 27.
00
28. SUBTOTAL.
Add lines 14 through 27
............................................................................. SUBTOTAL 28.
00
+
Continue on page 2. This form cannot be
0000 2016 25 01 27 5
processed if pages 2 and 3 are not completed and attached.
7. 2016 RESIDENCY STATUS:
Check all that apply.
Enter dates as MM-DD-YYYY (Example: 04-15-2016).
Reset Form
2016 MI-1040CR, Page 2 of 3
Filer’s Full Social Security Number
29. Enter subtotal from line 28.................................................................................................................... 29. 00
30.
Other adjustments (see instructions).
Describe: ________________________________________________ 30. 00
31.
Medical insurance/HMO premiums you paid for you and your family
(see instructions)
..................................................................................... 31. 00
32. Add lines 30 and 31. ............................................................................................................................. 32. 00
33.
TOTAL HOUSEHOLD RESOURCES. Subtract line 32 from line 29.
If more than $50,000, STOP; you are not eligible for this credit. .....................................................
33. 00
34. Multiply line 33 by 3.5% (0.035) or by the percent in Table 2 (see instructions). If negative, enter “0”
.
34.
00
35. Subtract line 34 from line 13 and enter the amount here. If line 34 is more than line 13, enter “0”
and STOP; you are not eligible for this credit. ....................................................................................... 35.
00
PART 1: ALLOWABLE COMPUTATION Complete one of the sections below, either A, B, or C (see instructions).
SECTION A: SENIOR CLAIMANTS (if you checked only box 5a)
36. Enter amount from line 35 ..................................................................................................................... 36. 00
37.
Percentage from Table A (see instructions) that applies to the amount
on line 33 ................................................................................................ 37. %
38. Multiply line 36 by line 37. Enter amount here and on line 42 (maximum $1,200) ................................
38. 00
SECTION B: DISABLED CLAIMANTS (if you checked only box 5b, or both boxes 5a and 5b)
39. Enter amount from line 35 here and on line 42 (maximum $1,200) ...................................................... 39. 00
SECTION C: ALL OTHER CLAIMANTS (if you did not check box 5a or 5b)
40. Enter amount from line 35. .................................................................................................................. 40. 00
41. Multiply amount on line 40 by 60% (0.60). Enter amount here and on line 42 (maximum $1,200). .... 41. 00
PART 2: PROPERTY TAX CREDIT CALCULATION All lers must complete this section.
42.
Enter amount from line 38, 39 or 41, or from Worksheet 3 (see instructions) for FIP/MDHHS
recipients.............................................................................................................................................. 42. 00
43.
Percentage from Table B (see instructions) that applies to the amount
on line 33
................................................................................................. 43.
%
44.
PROPERTY TAX CREDIT. Multiply amount on line 42 by percentage on line 43. Enter amount here
and if you le an MI-1040, carry this amount to MI-1040, line 25......................................................... 44. 00
NOTE: Seniors who pay rent (including rent paid to adult care facilities): Complete
Worksheet 4 in the MI-1040 book and enter amount from worksheet on line 44 (maximum
$1,200).
Continue on page 3. This form cannot be
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processed if pages 2 and 3 are not completed and attached.
2016 MI-1040CR, Page 3 of 3
Filer’s Full Social Security Number
PART 3: HOMEOWNERS WHO MOVED IN 2016. Report on lines 45 and 46 the addresses of the homesteads for which you
are claiming a credit. Homesteads with a taxable value greater than $135,000 are not eligible for this credit.
45. Address where you lived on December 31, 2016, if different than reported on line 1 (Number, Street, City, State, ZIP Code). Taxable Value
46. Address of homestead sold (moved from) during 2016 (Number, Street, City, State, ZIP Code). Taxable Value
HOMESTEAD
Homeowners who moved during 2016, complete lines 47 through 51.
A. Moved Into B. Moved From
47. Number of days occupied (total cannot be more than 366)............................................
48. Divide line 47 by 366 and enter percentage here
.......................................................... % %
49. Property taxes levied for calendar year 2016.................................................................
50. Prorated property taxes. Multiply line 49 by the percentages on line 48.....................
51. Taxes eligible for credit. Add line 50, columns A and B. Enter here and on line 10............................. 51. 00
PART 4: RENTERS
52.
A B C D E
Address of Homestead You Rented Landowner’s Name and Address # Months Monthly
Total Rent Paid
(Number, Street, Apt. #, City, State, ZIP Code) (City, State and ZIP Code) Rented Rent
53. Total rent you paid (not more than 12 months). Add total rent for each period. Enter here and on line 11. ...... 53. 00
PART 5: ALTERNATE HOUSING FACILITIES (see instructions)
54. If you lived in one of these types of facilities for all or part of 2016, check the appropriate box and see instructions.
a. Subsidized Housing: complete line 55. Enter result on line 11. b.
amounts paid on your behalf by a government agency
................................................................................ 55.
56. If you checked box 54b, multiply line 55 by 10% (0.10) (see instructions). Enter here and on line 10.
Service Fee Housing: complete lines 55 and 56.
55.
Enter the total rent you paid in 2016 while a resident of an Alternate Housing Facility. Do not include
00
... 56. 00
57.
Special Housing: If you lived in one of these types of facilities for all or part of 2016, check the appropriate box
(see instructions).
a. Cooperative Housing b. Home for the Aged c. Nursing Home
d. Adult Foster Care Home e. Paid Room and Board
Enter your prorated share of taxes from the type of facility checked on line 57 here and on line 10. ..... 57. 00
58. Name and Address (including City, State and ZIP Code) of Housing Facility, Landowner, or Care Facility if you completed Part 5.
DIRECT DEPOSIT
a. Routing Transit Number b. Account Number c. Type of Account
Deposit your refund directly to your nancial
1.
Checking
2.
Savings
institution! See instructions and complete
parts a, b and c.
Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2015, enter dates below.
Preparer Certication.
I declare under penalty of perjury that
ENTER DATE OF DEATH ONLY. Example: 04-15-2016 (MM-DD-YYYY)
this return is based on all information of which I have any knowledge.
Filer Spouse
Preparer’s PTIN, FEIN or SSN
Taxpayer Certication.
Preparer’s Name (print or type)
I declare under penalty of perjury that the information in this return
and attachments is true and complete to the best of my knowledge.
Filer’s Signature Date Preparer’s Business Name, Address and Telephone Number
Spouse’s Signature Date
By checking this box, I authorize Treasury to discuss my return with my preparer.
If you are also ling Form MI-1040, attach this form behind it. If not, mail this form to: Michigan Department of Treasury, Lansing, MI 48956
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