Reset Form            Print Form

                                                                   One Form MO-CRP must be provided for each rental location in which you resided. 
  Form                                                             Failure to provide landlord information may result in denial or delay of your claim.
   MO-CRP         2024 Certification of Rent Paid

1.  Social Security Number                                                               Spouse’s Social Security Number

                      -          -                                                                    -                 -

       Select this box if related to your landlord. If so, explain.
2.  Name (First, Last)

  Physical Address of Rental Unit (P.O. Box Not Allowed)                                                                 Apartment Number

  City                                                                                     State      ZIP Code

3.  Landlord’s Name (First, Last)

  Landlord’s Street Address (Must be completed)                                                                          Apartment Number

  City                                                                                     State      ZIP Code

4.  Landlord’s Phone Number (Must be completed) 
                           From:                                                           To: 
5.  Rental Period During Year (MM/DD/YY)                                      2024         (MM/DD/YY)                               2024

6.  Enter your gross rent paid. Attach a completed Verification of Rent Paid (Form 5674). If you received housing 
  assistance, enter the amount of rent you paid. Note: If you rent from a facility that does not pay property tax,   
  you are not eligible for a Property Tax Credit ....................................................                6              . 00

7.  Select the appropriate box below and enter the corresponding percentage on Line 7 ........................       7                       %

       A.  Apartment, House, Mobile Home, or Duplex - 100%                    F.  Low Income Housing - 100% (Rent cannot exceed 40% of total 
                                                                                 household income.)
       B.  Mobile Home Lot - 100%
                                                                              G. Shared Residence – If you shared your rent with relatives or friends  
       C.  Boarding Home or Residential Care - 50%                               (other than your spouse or children under 18), select the appropriate 
                                                                                 box based on the additional person(s) sharing rent:
       D.  Skilled or Intermediate Care Nursing Home - 45%
                                                                                       1 (50%)     2 (33%)             3 (25%)
       E.  Hotel - 100%; if meals are included - 50%
                                                                                                                     8
8.  Net rent paid - Multiply Line 6 by the percentage on Line 7............................................                         . 00
                                                                                                                     9
9.  Multiply Line 8 by 20%. Enter amount here and on Line 10 of Form MO-PTC or Line 12 of Form MO-PTS .......                       .        00

                                            *24315010001*
                                                                   24315010001
                                                    For Privacy Notice, see instructions.                               Form MO-CRP (Revised 12-2024)

Taxation Division                                   Ever served on active duty in the United States Armed Forces?  
Attach to Form MO-PTC or MO-PTS and                 If yes, visit dor.mo.gov/military/ to see the services and benefits DOR offers to all eligible military  
mail to the Missouri Department of Revenue.         individuals, or complete the survey at mvc.dps.mo.gov/MoVeteransInformation/Survey/DOR to  
                                                    receive information from the Missouri Veterans Commission. A list of all state agency resources 
                                                    and benefits can be found at veteranbenefits.mo.gov/state-benefits/.