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4 FINAL DRAFT - 10/2/23 4
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6 *231991* 6
7 2023 Form M99, Credit for Military Service in a Combat Zone 7
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10 TAXPAYER’S 1ST NAME,IN TAXPAYER’S LAST NAMEXXXXXXXXXXXXX 999999999 10
11 Your First Name and Initial Last Name Your Social Security Number 11
12 Check if: X New Address X Foreign Address 12
CURRENT HOME ADDRESSXXXXXXXXXXXX 999999999
13 Current Home Address Your Date of Birth (MM/DD/YYYY) 13
14 CITYXXXXXXXXXXXXXXXXXXXXXXXXXXXX XX 11223 14
15 City State ZIP Code X Check if Amended Form M99 15
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18 Enter the number of months served in a combat zone during 2023. Count partial months as full months. Your domicile must have been Minne- 18
19 sota during the months served to qualify for the credit. 19
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21 1 Number of months served in 2023 .... ..... ...... ...... ..... ..... ...... ...... ...... ..... ...... .... 1 12 21
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23 2 Multiply line 1 by $120. This is the AMOUNT OF YOUR CREDIT ..... ...... ...... ..... ...... ...... ..... 2 1234 23
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25 For Direct Deposit of the full credit, enter the following information. Otherwise, you will receive a check. 25
26 (You must use an account not associated with a foreign bank.) 26
27 Account Type 27
28 Checking Savings 28
29 X X 999999999999999999Routing Number 999999999999999999Account Number 29
30 Sign here: I declare that this return is correct and complete to the best of my knowledge and belief. 30
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32 11223333 1112223333 32
33 Your signature Date Phone 33
34 11223333 1112223333 123456789 34
Paid preparer’s signature Date Phone PTIN or VITA/TCE # (required)
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36 I authorize the Minnesota Department of Revenue to discuss this tax return with the preparer. 36
X
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38 Explanation of Amended Form — If you need to make changes to a Form M99 that you have already submitted, you must mail a new Form M99, 38
39 check the amended box on the form, and explain your changes below. If needed, enclose another sheet; include required documentation and mail 39
40 to the address on the form. 40
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42 EXPLAIN AMENDED XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 42
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
44 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 44
45 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 45
46 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 46
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You must enclose the following with this return:
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Active-duty members:
50 • Attach a copy of your Leave and Earnings Statement for each month in qualifying status. 50
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National Guard, Reservists, and retired or discharged active-duty members:
53 • Attach Form DD-214 for each period of qualifying service. 53
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We will accept completed forms and documentation starting September 15, 2023
56 Mail to: 56
57 Minnesota Department of Revenue 57
58 Mail Station 0043 58
59 600 N. Robert St. 59
60 St. Paul, MN 55146-0043 60
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63 9995 63
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