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    4                                                            FINAL DRAFT - 10/2/23                                                                                                                                              4
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    6                                                                                                                                                                                         *231561*                              6
    7  2023 Schedule M1PSC, Credit for Parents of Stillborn Children                                                                                                                                                                7
    8                                                                                                                                                                                                                               8
    9  Complete this schedule if all of the following are true:                                                                                                                                                                     9
    10 •  You experienced the birth of a stillborn child in 2023                                                                                                                                                                    10
    11 •  You received a Certificate of Birth Resulting in Stillbirth from Minnesota                                                                                                                                                11
    12 •  The child would have been your dependent in 2023 if they had been born alive                                                                                                                                              12
    13                                                                                                                                                                                                                              13
    14                                                                                                                                                                                                                              14
    15 FIRST NAME, INITXXXXXXXXXXXXX YOUR LAST NAMEXXXXXXXXX 999999999                                                                                                                                                              15
    16  Your First Name and Initial                              Last Name                                                                                                      Social Security Number                              16
    17                                                                                                                                                                                                                              17
    18   A   Did you experience the birth of a stillborn child in 2023? . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . .X   . Yes  NoX                                  18
    19      (If you answered no, STOP HERE. You do not qualify for this credit.)                                                                                                                                                    19
    20   B  Do you have a Certificate of Birth Resulting in Stillbirth from the Minnesota Department of Health?                                                              . . .  . . . . . .  . . . . .  . YesX     NoX          20
    21      (If you answered no, but experienced the birth of a stillborn child in Minnesota in 2023, see instructions.)                                                                                                            21
    22   C   Would you have claimed the child as your dependent in 2023 had the child been born alive?   . . .  . . . . .  . . . . . . .  . . . . . YesX     NoX                                                                    22
    23      (If you answered no, STOP HERE. You do not qualify for this credit.)                                                                                                                                                    23
    24                                                                                                                                                                                                                              24
    25   Enter the following information. If you have a Certificate of Birth Resulting in Stillbirth for more than one child in 2023, complete a separate                                                                           25
    26   schedule for each child and include with your Form M1.                                                                                                                                                                     26
    27                                                                                                                                                                                                                              27
    28   1   Name of Parent 1 on Certificate of Birth Resulting in Stillbirth   .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . .    1                                                           NAME PARENT1            28
    29                                                                                                                                                                                                                              29
    30   2  Name of Parent 2 on Certificate of Birth Resulting in Stillbirth (if listed)       . . .  . . . . . .  . . . . .  . . . . . . .    2                                                            NAME PARENT2            30
    31                                                                                                                                                                                                                              31
    32   3   Date of delivery on the Certificate of Birth Resulting in Stillbirth   . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  .    3                                                              11223333           32
    33                                                                                                                                                                                                                              33
    34   4  State file number on the Certificate of Birth Resulting in Stillbirth (see instructions)  . .  . . . . . .  . .    4                                                                     00000000000000                 34
    35                                                                                                                                                                                                                              35
    36   5  Document control number on the Certificate of Birth Resulting in Stillbirth (see instructions)  . .    5                                                                                 00000000000000                 36
    37                                                                                                                                                                                                                              37
    38   6   Credit allowed per child  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . .    6                                               2,000   38
    39      Full-year residents: Include this amount on line 4 of Schedule M1REF.                                                                                                                                                   39
    40   7  Part-year residents and nonresidents:  Multiply the amount on line 6 by line 30                                                                                                                                         40
    41      of Schedule M1NR. Enter the result here and on line 4 of Schedule M1REF.                                                                                                                                                41
    42      If your Minnesota gross income is less than $13,825, see instructions;                                                                                                                                                  42
    43      enter the result from step 5 of the worksheet here: 12345                                                                                                                                                               43
    44      Enter the result from step 6 here and on line 4 of Schedule M1REF            .  . . . . .  . . . . . . .  . . . . .  . . . . .  .      7                                                             12345678           44
    45                                                                                                                                                                                                                              45
    46   You must include this schedule with your Form M1.                                                                                                                                                                          46
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    63                                                                               9995                                                                                                                                           63
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2023 Schedule M1PSC Instructions

Am I eligible?
You may be eligible for a $2,000 refundable credit if all of these are true: 
•  You experienced the birth of a stillborn child in 2023
•  You received a Certificate of Birth Resulting in Stillbirth from the Minnesota Department of Health, Office of Vital Records
•  You would have claimed the child as a dependent in 2023 if the child had been born alive
If you are a part-year or nonresident, you may be eligible for this credit based on your percentage of income taxable to Minnesota .
What is a Certificate of Birth Resulting in Stillbirth?
A Certificate of Birth Resulting in Stillbirth is a record of birth issued by the Minnesota Department of Health, Office of Vital Records, to parents who 
have experienced a pregnancy loss (fetal death) resulting in stillbirth.
What is a state file number?
It is the number printed in the upper right area inside the margin on the Certificate of Birth Resulting in Stillbirth.
What if my certificate does not have a state file number?  
Call the Office of Vital Records at 651-201-5970 to ask for a replacement certificate. 
What is a document control number?
It is the number printed in the lower left corner under the barcode on the Certificate of Birth Resulting in Stillbirth.
How do I request a Certificate of Birth Resulting in Stillbirth?
Parents may request a Certificate of Birth Resulting in Stillbirth by contacting the Office of Vital Records. You can find the application online at  
www.health.state.mn.us/people/vitalrecords/docs/stillbirthapp.pdf.  Contact the Office of Vital Records at 651-201-5970 for any additional questions.
Do both parents need to request a Certificate of Birth Resulting in Stillbirth?
No. Only one credit is allowed per birth resulting in stillbirth. If you are filing a joint return with the person listed on the fetal death report, you 
only need to obtain one certificate for each birth resulting in stillbirth. If you are not filing jointly with the person listed on the fetal death report, 
you many claim the credit only if you would have claimed the child as a qualifying dependent in 2023, if they had been born alive .
How do I know if I would have had a qualifying dependent?
Generally, this means the child would have lived with you and would not have paid more than half of their own support . Minnesota uses the 
federal definition for a dependent. For more information, see IRS 501.
What if I experienced more than one birth of a stillborn child in 2023?
1 .   Complete a separate Schedule M1PSC for each child .
2 .   Add the amounts from line 6 or line 7, whichever applies, from each Schedule M1PSC .
3 .   Enter the result from step 2 on line 4 of Schedule M1REF .
Do I qualify for this credit if I had a stillborn child before 2023?
No . The delivery must have occurred in 2023 .
Do I qualify for this credit if I received a Certificate of Birth Resulting in Stillbirth from another state for a loss in 2023?
No. The Certificate of Birth Resulting in Stillbirth must be issued by the Minnesota Department of Health, Office of Vital Records.
What do I need to provide?
To qualify for this credit, you must have received a Certificate of Birth Resulting in Stillbirth issued by the Minnesota Department of Health for a deliv-
ery occurring in 2023. We may ask you to provide a copy of this record if we cannot verify the information.
Line Instructions
Line B
If you experienced the birth of a stillborn child in Minnesota in 2023 but did not request a Certificate of Birth Resulting in Stillbirth, you can request one 
by completing an application and submitting the form and fee to the Office of Vital Records. You can find the application online at www.health.state.
mn.us/people/vitalrecords/docs/stillbirthapp.pdf. You will need this certificate to complete Schedule M1PSC.
Line 7
If your Minnesota gross income is below the filing requirement and you’re filing Form M1 to claim this credit, you should have entered zero on line 30 
of Schedule M1NR, Nonresidents/Part-Year Residents.  To correctly determine this credit, you must first fully complete Schedule M1NR (do not skip 
lines 16-27) to determine what the amounts would have been, then complete the Worksheet for Line 7.

Worksheet for Line 7
1 Line 15, column B, of Schedule M1NR   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2  Line 27, column B, of Schedule M1NR   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
3  Subtract step 2 from step 1 . If zero or less, STOP HERE. You do not qualify .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
4  Line 29 of Schedule M1NR   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
5  Divide step 3 by step 4 (carry to five decimal places).  If step 3 is more than step 4, enter 1.0.   
  Enter result on the space provided on line 7 of Schedule M1PSC   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .                      .
6 Multiply step 5 by line 6 of Schedule M1PSC   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .
Enter the step 6 result on line 7 of Schedule M1PSC and on line 4 of Schedule M1REF .