*231811*
2023 Schedule M1LTI, Long-Term Care Insurance Credit

 Your First Name and Initial                                                 Last Name                                                                                         Social Security Number
If you (or your spouse, if filing a joint return) paid premiums in 2023 for a qualified long-term care insurance policy, complete this schedule 
to determine the amount of the credit you may claim when filing Form M1, Individual Income Tax .
To qualify for this credit, both of these must apply to your long-term care insurance policy:
 • It qualifies as an itemized deduction on Schedule M1SA, Minnesota Itemized Deductions, regardless of income limitations
 • It has a lifetime long-term care benefit limit of $100,000 or more
There are no separate instructions for Schedule M1LTI.

Policy Information (only one qualifying policy per person):
Name of Insured                                                              Insurance Company                                                                   Policy Number

Provide the information in the appropriate column for each insured person. If you are 
filing a joint return and both you and your spouse are covered by one policy, use half                                                           Round amounts to the nearest whole dollar.
of the premiums in column A and half in column B (below).
                                                                                                                                                                 A —You                        B —Spouse 

 1 Premiums paid in 2023 for the qualifying long-term care insurance policy   . . .  . . . . . . .  . . . . .  . .   1 
     Did you file Schedule M1SA? 
   • If no, skip lines 2, 3, and 4, and enter amounts from line 1 on line 5.
   • If yes, continue 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 Multiply line 5 by 25% (.25)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . .   6 

 7  The maximum credit is $100 per person   . . .  . . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . .   7                                100                  100

 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  Multiply 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. 

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