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Michigan Department of Treasury (Rev. 04-21), Page 1 of 3 
                                                                                                                                                            Amended Return 
2021 MICHIGAN Homestead Property Tax Credit Claim MI-1040CR 
Issued under authority of Public Act 281 of 1967, as amended. 

Type or print in blue or black ink.                                                                                                                         Attachment 05 
1. Filer’s First Name                     M.I.       Last Name                                         2. Filer’s Full Social Security No. (Example: 123-45-6789) 

If a Joint Return, Spouse’s First Name    M.I.       Last Name 
                                                                                                       3. Spouse’s Full Social Security No. (Example: 123-45-6789) 
Home Address (Number, Street, P.O. Box). If using a P.O. Box, you must complete line 45. 

City or Town                                                        State ZIP Code                     4. School District Code (5 digits - see page 60) 

5. Check the box(es) for which you or your spouse qualify (excluding dependents). If you qualify for both, see instructions. 
a.    Age 65 or older; or an unremarried spouse of a person                              b.  Deaf, blind, hemiplegic, paraplegic, quadriplegic, or 
      who was 65 or older at the time of death.                                              totally and permanently disabled. 
6. 2021 FILING STATUS:                 7. 2021 RESIDENCY STATUS:                             *If you checked box “c,” enter dates of Michigan residency in 2021. 
   Check one.                             Check all that apply.                              Enter dates as MM-DD-YYYY (Example: 04-15-2021). 
a.   Single                            a.      Resident                                                FILER                                                SPOUSE 

b.   Married filing jointly            b.      Nonresident                FROM:                                                   2021                             2021
c.   Married filing separately                                                           TO:                                      2021                             2021 
                                       c.      Part-Year Resident * 
     (Include Form 5049) 
8. Homestead Status 
     Check here if the taxable value of your homestead includes unoccupied farmland classified as agricultural by your local assessor. 

9.   Homeowners: Enter the 2021 taxable value of your homestead (see instructions). If you did not 
     check box 8 above and your taxable value is greater than $136,600, STOP; you are not eligible. 
     Farmers: enter the taxable value of your homestead, including eligible unoccupied farmland   .............                                         9.                 00 

10.  Property taxes levied on your home for 2021 (see instructions) or amount from line 51, 56 and/or 57  10.                                                              00 

11.  Renters: Enter rent you paid for 2021 from line 53 and/or 55  ...............  11.                                               00 

12.  Multiply line    11 by 23% (0.23)................................................................................................................  12.                00 

13.  Total. Add lines 10 and 12  ....................................................................................................................  13.                 00 
TOTAL HOUSEHOLD RESOURCES. If filing a joint return, include income from both spouses. 
If married filing separately, you must include Form 5049. 

14.  Wages, salaries, tips, sick, strike                                                 21.  Social Security, SSI, and/or 
     and SUB pay, etc..........................      14.                  00                 railroad retirement benefits.  ..  21.                                        00 
15.  All interest and dividend income                                                    22.  Child support and foster 
     (including nontaxable interest)......           15.                  00                 parent payments...................                         22.                00 
16.  Net business income (including net                                                  23.  Unemployment 
     farm income). If negative enter “0”             16.                  00                 compensation. ......................  23.                                     00 
17.  Net royalty or rent income.                                                         24.  Gifts received or expenses 
     If negative enter “0”.  .....................   17.                  00                 paid on your behalf.  ..............  24.                                     00 
18.  Retirement pension, annuity, and                                                    25.  Other nontaxable income 
     IRA benefits. ................................. 18.                  00                 Describe: _______________  25.                                                00 
19.  Capital gains less capital losses,                                                  26. Workers’/veterans’ disability 
     (see instructions). .........................   19.                  00                 compensation/pension benefits                              26.                00 
20.  Alimony and other taxable income                                                    27. FIP and other MDHHS benefits 
     Describe:  ___________________                  20.                  00                 (Do not include food assistance)                           27.                00 

28.  SUBTOTAL. Add lines 14 through 27               .............................................................................SUBTOTAL              28.                00 
                                                                                                                                  Continue on page 2.  This form cannot be 
                                                                                             processed if pages 2 and 3 are not completed and included. 
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2021 MI-1040CR, Page 2 of 3 
                                              Filer’s Full Social Security Number 

29.  Enter subtotal from line 28....................................................................................................................  29.          00 
30.  Other adjustments (see instructions). 
     Describe: ________________________________________________  30.                                                    00 
31.  Medical insurance/HMO premiums you paid for you and your family 
     (see instructions)  .....................................................................................  31.     00 

32.  Add lines 30 and 31..............................................................................................................................  32.        00 
33.  TOTAL HOUSEHOLD RESOURCES. Subtract line 32 from line 29. 
     If more than $60,600, STOP; you are not eligible for this credit.  .....................................................                           33.        00 

34.  Multiply line 33 by 3.2% (0.032) or by the percent in Table 2 (see instructions). If negative, enter “0”.                                          34.        00 
35.  Subtract line 34 from line 13 and enter the amount here. If line 34 is greater than line 13, enter “0” 
     and STOP; you are not eligible for this credit........................................................................................             35.        00 

PART 1: ALLOWABLE COMPUTATION Complete one of the sections below, either A, B, or C (see instructions). 

SECTION A: SENIOR CLAIMANTS (if you checked only box 5a) 

36.  Enter amount from line 35  .....................................................................................................................  36.         00 
37.  Percentage from Table A (see instructions) that applies to the amount 
     on line 33 ................................................................................................  37.   % 

38.  Multiply line 36 by line 37. Enter amount here and on line 42 (maximum $1,500)  ................................  38.                                         00 

SECTION B: DISABLED CLAIMANTS (if you checked only box 5b, or both boxes 5a and 5b) 

39.  Enter amount from line 35 here and on line 42 (maximum $1,500)  ......................................................  39.                                   00 

SECTION C: ALL OTHER CLAIMANTS (if you did not check box 5a or 5b) 

40.  Enter amount from line 35.  ..................................................................................................................  40.           00 

41.  Multiply amount on line 40 by 60% (0.60). Enter amount here and on line 42 (maximum $1,500). ....                                                  41.        00 

PART 2: PROPERTY TAX CREDIT CALCULATION All filers must complete this section. 
42.  Enter amount from line 38, 39 or 41, or from Worksheet 4 (see instructions) for FIP/MDHHS 
     recipients..............................................................................................................................................  42. 00 
43.  Percentage from Table B (see instructions) that applies to the amount 
     on line 33  .................................................................................................  43. % 
44.  PROPERTY TAX CREDIT. Multiply amount on line 42 by percentage on line 43. Enter amount here 
     and if you file an MI-1040, carry this amount to MI-1040, line 25..  .......................................................  44.                             00 

     NOTE: Seniors who pay rent (including rent paid to adult care facilities):                                         Complete 
     Worksheet 5 in the MI-1040 book and enter amount from worksheet on line 44 (maximum 
     $1,500). 

                                                                                                                        Continue on page 3.  This form cannot be 
                                                                           processed if pages 2 and 3 are not completed and included.
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2021 MI-1040CR, Page 3 of 3
Filer’s Full Social Security Number

PART 3: HOMEOWNERS WHO MOVED IN 2021. Report on lines 45 and 46 the addresses of the homesteads for which you
are claiming a credit. Homesteads with a taxable value greater than $136,600 are not eligible for this credit.
45. Address where you lived on December 31, 2021, if different than reported on line 1 (Number, Street, City, State, ZIP Code). Taxable Value
00
46. Address of homestead sold (moved from) during 2021 (Number, Street, City, State, ZIP Code). Taxable Value
00
HOMESTEAD
Homeowners who moved during 2021, complete lines 47 through 51. A. Moved Into B. Moved From
47. Number of days occupied (total cannot be more than 365)............................................
48. Divide line 47 by 365 and enter percentage here .......................................................... % %
49. Property taxes levied for calendar year 2021 ................................................................. 00 00
50. Prorated property taxes. Multiply line 49 by the percentages on line 48 ..................... 00 00
51. Taxes eligible for credit. Add line 50, columns A and B. Enter here and on line 10............................. 51. 00
PART 4: RENTERS
52. A B C D E
Address of Homestead You Rented Landowner’s Name and Address # Months Monthly
(Number, Street, Apt. #, City, State, ZIP Code) (City, State and ZIP Code) Rented Rent Total Rent Paid

00 00

00 00
53. Total rent you paid (not more than 12 months). Add total rent for each period. Enter here and on line 11....... 53. 00
PART 5: ALTERNATE HOUSING FACILITIES (see instructions)
54. If you lived in one of these types of facilities for all or part of 2021, check the appropriate box and see instructions.

a. Subsidized Housing: complete line 55. Enter result on line 11. b. Service Fee Housing: complete lines 55 and 56.
55. Enter the total rent you paid in 2021 while a resident of an Alternate Housing Facility. Do not include
amounts paid on your behalf by a government agency ................................................................................ 55. 00

56. If you checked box 54b, multiply line 55 by 10% (0.10) (see instructions). Enter here and on line 10. ... 56. 00
57. Special Housing: If you lived in one of these types of facilities for all or part of 2021, check the appropriate box
(see instructions).
a. Cooperative Housing b. Home for the Aged c. Nursing Home

d. Adult Foster Care Home e. Paid Room and Board
Enter your prorated share of taxes from the type of facility checked on line 57 here and on line 10. ..... 57. 00
58. Name and Address (including City, State and ZIP Code) of Housing Facility, Landowner, or Care Facility if you completed lines 54 through 57.

DIRECT DEPOSIT a. Routing Transit Number b. Account Number c. Type of Account
Deposit your refund directly to your financial Checking 2. Savings
institution! See instructions and complete 1.
parts a, b and c.
Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2020, enter dates below. Preparer Certification. I declare under penalty of perjury that
ENTER DATE OF DEATH ONLY. Example: 04-15-2021 (MM-DD-YYYY) this return is based on all information of which I have any knowledge.
Preparer’s PTIN, FEIN or SSN
Filer Spouse
Taxpayer Certification. I declare under penalty of perjury that the information in this return Preparer’s Name (print or type)
and attachments is true and complete to the best of my knowledge.
Filer’s Signature Date Preparer’s Signature

Spouse’s Signature Date Preparer’s Business Name, Address and Telephone Number

By checking this box, I authorize Treasury to discuss my return with my preparer.

If you are also filing Form MI-1040, include this form behind it. If not, mail this form to: Michigan Department of Treasury, Lansing, MI 48956

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PDF file checksum: 3052588845

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