Fillable 2021 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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2021 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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2021 CRP, Cercate of Rent Paid
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 (MM/DD/YYYY)
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allCRPsforyourrecords.
Note: Thepropertyownerormanagingagentmust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.
9995
*215231*
Renter/Unit Informaon
RenterFirstNameandInial RenterLastName ElectronicCercateNumber(ECN)
RentalUnitAddress Unit Rentedfrom(MM/DD/YYYY)to(MM/DD/YYYY)
City State ZIPCode County TotalMonthsRented TotalAdultsLivinginUnit
Property Informaon
PlaceanXifthepropertyis:
(1) AdultFosterCare (2) AssistedLiving (3) IntermediateCareFacility
PropertyIDorParcelNumber
(4) NursingHome (5) MobileHome (6) MobileHomeLot
NumberofUnitsonThisProperty
Rent Details
A. WasanyrentpaidbyMedicalAssistance(see instrucons)? (A) Yes No Ifyes,enteramount: A
B.DidtherenterreceiveMinnesotaHousingSupport(formerlyGRH)(see instrucons)? (B) Yes No Ifyes,enteramount:B
Total Rent
1 Renter’sshareofrentpaid(see instrucons)........................................................... 1
2 Caretakerrentreducon(see instrucons) ........................................................... 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
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2021 CRP, Cercate of Rent Paid (Minnesota Department of Revenue)

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Completed 3 January 2022

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