2017 CRP, Cercate of Rent Paid
Renter’s Name and Address of the Unit Rented Owner’s or Managing Agent’s Name and Address (Including ZIP Code)
Property ID Number or Parcel Number County Number of Units on This Property
Rented from (MM/DD/YYYY): to (MM/DD/YYYY): Total Months Rented Number of Adults Living in Unit (count married couple as 1) Place an X in box
if count includes
Place an X if: Nursing Home Intermediate Care Facility Adult Foster Care Assisted Living
A. Amount paid for the renter by medical assistance (Medicaid) ..............................
B. GroupResidenalHousing(GRH)paymentsreceivedbylandlordonbehalfofthisrenter .......
1 Rent paid to you by this individual renter or married couple for 2017 (round to nearest whole dollar).................. 1
If a government housing agency paid you part of the rent for this unit, place an X in this box,
but do not include the amounts paid by the government agency in line 1.
Place an X in this box if rent was for a mobile home lot.
Place an X in this box if this renter received reduced rent for being caretaker.
2 The percentage for all renters is 17 percent (.17) ........................................................... 2
3 Mulplyline1byline2.Renters: Include this amount on line 9 of Form M1PR
(round to nearest whole dollar)
Landlord: I declare that this cercate is correct and complete to the best of my knowledge and belief.
Owner’s or agent’s signature Date Business phone
Eligible renters (see eligibility requirements below) may receive a refund based on property taxes paid on their principal place of residence in
Minnesota and their income. Renters will need this CRP to apply for a property tax refund.
The landlord is required to give each renter a completed CRP, Cercate of Rent Paid, no later than January 31, 2018.
Roommates: The landlord is required to give each unmarried renter living in a unit a separate CRP showing that each roommate paid an equal
Renters: You must le Form M1PR and include all CRPs to claim a refund. Your refund will be denied or delayed if you do not include all CRPs
when ling Form M1PR.
Eligibility Requirements for Renters
• You were a full-year or part-year resident of Minnesota;
• You cannot be claimed as a dependent on someone else’s 2017 federal income tax return; and
• Your total household income is less than $59,960. (Household income is your federal adjusted gross income plus most nontaxable income. If
you are married and living together, both incomes are included in household income. If you are single, use your income only; do not include the
If you meet the above eligibility requirements, complete Form M1PR, Homestead Credit Refund (For Homeowners) and Renters Property Tax Refund,
If you qualify, complete and le Form M1PR. You must include this CRP when you le your M1PR return. Your refund will be delayed or denied if
you do not include this CRP when you le your M1PR. Make copies of Form M1PR and this form and keep them with your records.