2019 Schedule M1PR-AI, Addions to Income
9995
Your First Name and Inial Last Name Your Social Security Number
If a Joint Return, Spouse’s First Name and Inial Spouse’s
Last Name
Spouse’s Social Security Number
*195711*
Complete Schedule M1PR-AI, Addions to Income, to report amounts for line 5 of Form M1PR, Homestead Credit Refund (for Home-
owners) and Renters Property Tax Refund. Enter the type of income that was received in Column A and the amount in Column B.
See instrucons to determine which types of income to include.
Column A — Type of Income Received Column B —Amount
You must include this schedule with your Form M1PR. If you had more than 19 items, include a statement with the type of income
and amounts received.
1a 1b
2a 2b
3a 3b
4a 4b
5a 5b
6a 6b
7a 7b
8a 8b
9a 9b
10a 10b
11a 11b
12a 12b
13a 13b
14a 14b
15a 15b
16a 16b
17a 17b
18a 18b
19a 19b
20 Total of Column B. Add all amounts in Column B. Enter here and on line 5 of Form M1PR ..................20