*215211*
2021 Form M1PR, Homestead Credit Refund (for Homeowners)
and Renters Property Tax Refund
Your First Name and Inial Last Name Your Social Security Number Your Date of Birth (MM/DD/YYYY)
If a Joint Return, Spouse’s First Name and Inial Spouse’s
Last Name
Spouse’s Social Security Number
Spouse’s Date of Birth
Current Home Address
Check if Address is: New Foreign
City State ZIP Code
Check all that apply:
Renter Homeowner Nursing Home or Adult Foster Care Resident Mobile Home Owner
State Elecons Campaign Fund: To grant $5 to this fund, enter the code for the party of your choice. It will help candidates for state oces pay campaign expenses.
This will not increase your tax or reduce your refund.
Polical Party Code Numbers:
Democrac/Farmer-Labor ...12 Grassroots/Legalize Cannabis 14
Your Code Spouse’s Code
Republican................11
Independence .............13 Libertarian ................16
1 Federal adjusted gross income (from Line 1 of Form M1, see instrucons if you did not le Form M1)
......... 1
2 Nontaxable Social Security and/or Railroad Rerement Board benets received
and not included in line 1 above (determine from instrucons) ......................................... 2
3 Deducon for contribuons to a qualied rerement plan
(add lines 16 and 20 of federal Schedule 1; see instrucons) Also see line 9 of this Form M1PR............... 3
4 Total payments from programs including MFIP (MN Family Investment Program), MSA (MN Supplemental Aid)
SSI (Supplemental Security Income), GA (General Assistance), and Minnesota Housing Support (formerly GRH) 4
5
Addional nontaxable income from line 20 of Schedule M1PR-AI, Addions to Income ........................
5
6 Add lines 1 through 5 (if you are a renter and this line is less than the rent you paid, enclose an explanaon) .. 6
7 Subtracon for 65 or older (born before January 2, 1957) or disabled:
If you (or your spouse if ling a joint return) are age 65 or older or are disabled, enter $4,350: ............. 7
Check the box if you or
your spouse are:
(A) 65 or Older
(B)Disabled
8 Dependent Subtracon: Enter your subtracon for dependents (use worksheet in instrucons) ............ 8
Number of dependents: Names and Social Security numbers:
9 Rerement Account Subtracon: If you (or your spouse) contributed to a 401(k), IRA, 457(b), or
other rerement plan, or had an amount on line 3, see instrucons .................................... 9
10 Your non-deducble alimony payments and COVID-related IRA distribuons from prior years (see instrucons)10
11 If you have a negave amount on line 35 of Schedule M1NC, enter the amount on line 11 (see instrucons) .. 11
12 Add lines 7 through 11 ......................................................................... 12
13 Subtract line 12 from line 6 ..................................................................... 13
14 Co-occupant Income (from line 13 of Worksheet 5 - Co-occupant Income. If negave, enter as a negave).... 14
15 Add line 14 to line 13 .......................................................................... 15
Renters - Complete lines 16-18. Homeowners - Connue to next secon.
16 Enter total rent from Cercates of Rent Paid (CRPs) (you must enclose your CRPs) ....................... 16
17 Mulply line 16 by 17% (.17) ................................................................... 17
18 Renters Refund. Using the amount from line 13 and line 17, nd the amount to enter here from the renters
refund table in the instrucons. You must connue with lines 23-25 on the next page. ................... 18
Legal Marijuana Now .......17
General Campaign Fund.....99
9995
2021 Form M1PR, page 2
Homeowners
*215221*
Property ID Number County where property is located
19 Property tax from line 1 of Statement of Property Taxes Payable in 2022 ............................. 19
(Mobile homeowners: See worksheet 1 in the instrucons)
20 If claiming the special refund, enter amount from line 38 of Schedule 1 below (see instrucons).......... 20
21 Subtract line 20 from line 19 (if result is zero or less, leave blank) .................................... 21
22 Homestead Credit Refund: Using the amounts from line 15 and line 21,
nd the amount to enter here from the homeowners refund table in the instrucons ................... 22
Homeowners and Renters
23 Add lines 18, 20, and 22 ...................................................................... 23
24 Nongame Wildlife Fund contribuon. Your refund will be reduced by this amount ............
24
25 Your Refund. Subtract line 24 from line 23. Connue to line 39....................................... 25
Schedule 1 - Special Refund
To qualify, you must have owned and lived in this homestead both on January 2, 2021, and on January 2, 2022. If you qualify, see the instrucons.
26 Line 1 of Statement of Property Taxes Payable in 2022. If the Statement does not list an amount for new
improvements or expired exclusions, skip lines 27 and 28 and enter this amount on line 29 .............. 26
27 If the Statement lists an amount for new improvements or expired exclusions, complete and enclose
Worksheet 3 from the instrucons and enter the percentage from Step 3 here......................... 27
%
28 Mulply line 26 by the percentage on line 27 .................................................... 28
29 If you did not have new improvements or expired exclusions, enter the amount from line 26.
If you had new improvements or expired exclusions, subtract line 28 from line 26. ..................... 29
30 From your Statement of Property Taxes Payable in 2022, enter the amount from line 2 (2021 column).
If there is no amount on line 2, see instrucons. .................................................. 30
Disabled Veterans Homestead Exclusion (see instrucons)
31 Special refund (not your regular refund) from line 20 of your 2020 Form M1PR ........................ 31
32 Subtract line 31 from line 30 (if result is a negave number or more than line 29, STOP HERE;
you are not eligible for the special refund) ....................................................... 32
33 Subtract line 32 from line 29 (if result is less than $100, STOP HERE;
you are not eligible for the special refund) ....................................................... 33
34 Amount from Line 32 ___________ X 12% (.12) .................................................. 34
35 Amount from line 34 or $100, whichever is greater................................................ 35
36 Subtract line 35 from line 33 (if result is zero or less, STOP HERE; you are not eligible for this special refund) 36
37 Mulply line 36 by 60% (.60) .................................................................. 37
38 Special Refund. Amount from line 37 or $1,000, whichever is less.
Enter the amount here and on line 20 of this Form M1PR. .......................................... 38
39 Direct deposit of your refund (you must use an account not associated with a foreign bank):
Checking Savings
Roung Number Account Number
Taxpayer: I declare that this return is correct and complete to the best of my knowledge and belief.
Your Signature Spouse’s Signature (If Filing Jointly) Date (MM/DD/YYYY) Dayme Phone
Paid Preparers Signature Date (MM/DD/YYYY) PTIN or VITA/TCE # (required)
I authorize the Minnesota Department of Revenue to discuss this tax return with the preparer.
Mail to: Minnesota Property Tax Refund St. Paul, MN 55145-0020 Renters — Include your 2021 CRP(s).
Preparer’s Dayme Phone
9995