Fillable 2021 Schedule M1LTI, Long-Term Care Insurance Credit (Minnesota Department of Revenue)

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2021 Schedule M1LTI, Long-Term Care Insurance Credit (Minnesota Department of Revenue)

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The 2021 Schedule M1LTI, Long-Term Care Insurance Credit (Minnesota Department of Revenue) form is 1 page long and contains:

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1 Premiums paid in 2021 for the qualifying long-term care insurance policy ................. 1
DidyouleScheduleM1SA?
• If no, skip lines 2, 3, and 4, and enter line 1 on line 5.
• If yes,connuewithline2.
2 Amountofpremiumspaidonthispolicythatareincludedonline1ofScheduleM1SA ....... 2
3 Amountfromline4ofScheduleM1SA(If you and your spouse are claiming
premiums paid, enter half of this amount in each column)................................ 3
4 Amountfromline2orline3,whichever is less ....................................... 4
5 Subtractline4fromline1......................................................... 5
6 Mulplyline5by25%(.25)........................................................ 6
7 The maximum credit is $100 per person ............................................. 7
8 Amountfromline6orline7,whichever is less ....................................... 8
9 Addline8,columnsAandB ......................................................................... 9
Full-year residents: Alsoenterthisamountonline2ofScheduleM1C.
Part-year Residents and Nonresidents
10 Mulplyline9byline30ofScheduleM1NR.
Entertheresulthereandonline2ofScheduleM1C .................................................... 10
You must include this schedule with your Form M1.
9995
Policy Informaon (only one qualifying policy per person):
Name of Insured Insurance Company Policy Number
Providetheinformaonintheappropriatecolumnforeachinsuredperson.Ifyouare
lingajointreturnandbothyouandyourspousearecoveredbyonepolicy,usehalf
ofthepremiumsincolumnAandhalfincolumnB(below).
2021 Schedule M1LTI, Long-Term Care Insurance Credit
Your First Name and Inial Last Name Social Security Number
Ifyou(oryourspouse,iflingajointreturn)paidpremiumsin2021foraqualiedlong-termcareinsurancepolicy,completethisschedule
todeterminetheamountofthecredityoumayclaimwhenlingFormM1.
Toqualifyforthiscredit,bothofthesemustapplytoyourlong-termcareinsurancepolicy:
• Itqualiesasanitemizeddeducon(seeScheduleM1SA,Minnesota Itemized Deducons),disregardingtheincometest
• Ithasalifemelong-termcarebenetlimitof$100,000ormore
TherearenoseparateinstruconsforScheduleM1LTI.
100 100
A —You B —Spouse
Round amounts to the nearest whole dollar.
*211811*
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2021 Schedule M1LTI, Long-Term Care Insurance Credit (Minnesota Department of Revenue)

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Completed 24 March 2022

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