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2023 Form PCR, Political Contribution Refund Application
Complete this form to claim a refund of contributions made to Minnesota political parties and candidates for Minnesota state offices. 
Include with this form your original Form EP-3, Minnesota Political Contribution Receipt, for all your contributions made between 
January 1, 2023, and December 31, 2023. DO NOT STAPLE.

Your First Name and Initial                               Your Last Name                                                           Your Social Security Number

If a Joint Return, Spouse’s First Name and Initial        Spouse’s Last Name                                                       Spouse’s Social Security Number
                                                                            Check if: New Address     Foreign Address
Mailing Address                                                                                                                    Your Date of Birth

City                                                      State             ZIP Code                 Number of Forms EP-3 attached Spouse’s Date of Birth

Place an X in one box (Married couples: See the notice below)

       (1) Single                    (2) Married, filing joint application              (3) Married, filing separate application

You may file only one application each year. You cannot file another application for the same year or amend an application after you file it. 

 1 Add all contributions you (and your spouse, if filing a joint application) made during 2023 shown on  
   your Form(s) EP-3 attached to this application. Enter the total . . . .  .. ...... ...... ...... ..... ...... ..... ..    1      

 2  If you are a married couple filing a joint application, enter $100. If you are 
   single, or married but filing a separate application, enter $50  .. ...... ...... ...... ..... ...... ..... ......    2   

 3  Enter the amount from line 1 or line 2 above, whichever is less.
   This is your refund amount  ... ...... ..... ....... ..... ...... ..... ..... ...... ...... ...... ..... ...... .3   

 4  For direct deposit of the full refund amount on line 3, enter your bank account information. (Use an account not associated with any foreign banks.)   

   Account type:                     
      Checking                      Savings 
                                            Routing Number                            Account Number
 
I declare that this form is correct and complete to the best of my knowledge and belief.

Your Signature                                       Spouse’s Signature (If a joint application)      Date                              Daytime Phone

Married Couples
  •  You must choose to file either a joint application or separate applications; you cannot file both.
  •   If you file a separate application, do not enter your spouse’s name, Social Security Number, or date of birth.  
     Do not have your spouse sign your application.

Mail this application no later than April 15, 2024, to:
                                   Minnesota Department of Revenue
                                   Political Contribution Refund
                                   600 N. Robert St.
                                   St. Paul, MN 55146-1800

                                                                                     9995

2023 Form PCR Instructions

If you are a Minnesota voter who contributed gifts or money to Minnesota political parties or candidates for Minnesota state offices, you may 
apply for a refund of all or a portion of contributions made between January 1, 2023, and December 31, 2023. The maximum refund is $50 for 
an individual and $100 for a married couple filing a joint application.
You (and your spouse if filing a joint application) may file only one Form PCR for each calendar year you made contributions, even if 
you contributed to more than one candidate or party.
You may receive a refund for all or a portion of contribu tions you made between January 1, 2023, and December 31, 2023, to candidates who 
have signed an agreement with the Minnesota Campaign Finance and Public Disclosure Board to observe the state campaign spending limit 
law. Your contributions to candidates for these state offices may qualify:
•  Minnesota House of Representatives
•  Minnesota State Senate
•  Governor and Lieutenant Governor of Minnesota
•  Attorney General of Minnesota
•  Secretary of State of Minnesota
•  Minnesota State Auditor
You may also receive a refund of all or a portion of contri butions you made to any of these:
• Democratic-Farmer-Labor Party
•  Republican Party of Minnesota
• Grassroots-Legalize Cannabis Party
•  Independence Party of Minnesota
• Legal Marijuana Now Party
•  Libertarian Party of Minnesota
• Any precinct, city, county, congressional or legislative district unit of the Minnesota parties listed above.

Who can claim this refund?
You must be, or be eligible to be, a registered voter in Minnesota. Also, all of these must apply:
•  You are a United States citizen.
•  You are age 18 years or older.
•  You lived in Minnesota for at least 20 days immediately before any 2023 statewide or local election in which you would be eligible to vote 
  if you were registered.
You are not eligible for the refund, regardless of whether or not you are a registered voter, if any of these are true:
•  You are under a person’s guardianship, but have not retained the right to vote.
•  You have been found by a court to be legally incompetent to vote.
•  You have been convicted of a felony and your civil rights have not been restored.

Include EP-3 Forms
To receive your refund, you must include with your Form PCR the original Form EP-3, Minnesota Political Contribution Receipt, you re-
ceived for each contribution. 
If you do not include the original receipts, we will send your form back to you. You must have made contributions between January 1, 2023, 
and December 31, 2023, to file the 2023 Form PCR. 

When to File
You may apply for your refund at any time, but no later than April 15, 2024.
Do not mail your application in the same envelope with your Minnesota income tax return. You cannot use the amount of your Political 
Contribution Refund as a credit on your Form M1. Including Form PCR in the same envelope as your return may delay processing of both 
forms.

Amended Returns, Extensions for Filing are Not Permitted
You cannot amend Form PCR. You cannot get an extension to file Form PCR. You must file the form by April 15, 2024. We will not issue 
refunds for 2023 Forms PCR filed after this date.

                                                                                                                            Continued

Form PCR Instructions for 2023, Cont.

Completing Form PCR
Important: In the heading of Form PCR, you must enter your name, address, date of birth, and Social Security Number (and your spouse’s 
name, date of birth, and Social Security Number, if filing a joint application). Also, be sure to indicate the number of receipts you are attach-
ing. If you do not include this information, your refund may be delayed.
Filing Status Boxes
If you are not married, check the Single box.
If you are married, you and your spouse may either:
•  File one application together with your spouse for a maximum refund of $100.
•  File separate applications for a maximum refund of $50 each.
If you choose to file a joint application, you must enter the name, date of birth, and Social Security Number for both you and your spouse. 
Check the box for Married, filing joint application.
If you are married and choose to file separate applications, do not include your spouse’s name, date of birth, and Social Security Number. 
Enter your name only and check the box for Married, filing separate application. 
Line Instructions
Line 1
Add the amounts shown on all of your Form EP-3 receipts, and enter the total on line 1. Your receipts must be for contributions made be-
tween January 1, 2023, and December 31, 2023.
Line 2
If you are filing a joint application, enter $100. If you are single, or married and filing a separate application, enter $50.
Line 3
Enter the amount from line 1 or line 2, whichever is less.
You will receive the total of your contributions up to the maximum refund, which is $100 if you are married filing a joint application or $50 if 
you are single, or married filing a separate application. 
Line 4
If you want the refund to be directly deposited into your checking or savings account, enter the requested information on line 4. 
Note: You must use an account not associated with any foreign banks.

The routing number must have nine digits.
The account number may contain up to 17 digits (both numbers and letters). Leave out any hyphens, spaces, and symbols.

If You Owe Taxes or Debts
If you owe any Minnesota or federal taxes, criminal fines, or a debt to a state agency, district court, qualifying hospital, or public library, we 
may apply your refund to the amount you owe (including any penalty and interest).

Use of Information
All information you provide on Form PCR is private by state law and cannot be given to others, including your spouse, without your con-
sent, except to the IRS, to other states that guarantee its privacy by law, to Minnesota courts, and to other Minnesota state, county, and local 
government agencies. All information on this form, other than your phone number and bank account, is required to properly identify that you 
qualify for this refund. If all required information is not provided, your application may be delayed or denied. Your Social Security Number is 
required under Minnesota Statute 270C.306.
Your Social Security Number and all other information on Form PCR are private and cannot be disclosed to others without your consent 
except as listed above. Your contribution can be counted with those of other contributors to that candidate or political party, and the total can 
be given to the Minnesota Campaign Finance and Public Disclosure Board.

Forms and Information
• Website:  www.revenue.state.mn.us
• Email:     individual.incometax@state.mn.us
• Phone:     651-296-3781 or 1-800-652-9094