Fillable 2019 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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2019 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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2019 CRP, Cercate of Rent Paid
Renter/Unit Informaon
Renter First Name and Inial Renter Last Name Electronic Cercate Number (ECN)
Rental Unit Address Unit City State ZIP Code County
Rented from (MM/DD/YYYY) to (MM/DD/YYYY) Total Months Rented Number of Adults Living in Unit
Property Informaon
Place an X if the property is: Adult Foster Care Assisted Living Intermediate Care Facility
Nursing Home Mobile Home Mobile Home Lot
Property ID or Parcel Number Number of Units on This Property
Rent Details
A. Was any rent paid by medical assistance (Medicaid)? Yes No If yes, enter amount: A
B. Did the renter receive housing support? Yes No If yes, enter amount: B
Total Rent
1 Renter’s share of rent paid.......................................................................... 1
2 Caretaker rent reducon ........................................................................... 2
3 Total rent (Add lines 1 and 2) .........................................................................3
Property Owner
Property Owner Name Dayme Phone
Property Owner Address City State ZIP Code
Sign Here
I declare that this cercate is correct and complete to the best of my knowledge and belief.
Owner or Agent Signature Date
Managing Agent Name, If Applicable (please print) Dayme Phone
Renter Instrucons
Use this cercate to complete Form M1PR, Homestead Credit Refund (for Homeowners) and Renter’s Property Tax Refund. When you le Form M1PR, you
must aach all CRPs used to determine your refund. Keep copies of Form M1PR and CRPs for your records.
Note: The property owner or managing agent is required to give each renter living in a unit a separate CRP showing that they paid an equal poron of the
rent, regardless of the poron actually paid.
For forms and tax-related informaon, go to our website at www.revenue.state.mn.us or call 651-296-3781 or 1-800-652-9094 (toll-free).
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2019 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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Completed 29 July 2020

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