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                                                                                                                                                           Department Use Only
                                                                                         Form                                                              (MM/DD/YY)
                                                                                         MO-CFC     Champion for Children Tax Credit

                                                                                              Taxable Year Beginning                                       Ending
                                                                                                           (MM/DD/YY)                                      (MM/DD/YY)

                                                                                         Taxpayer’s                                       Social Security
                                                                                         Name                                             Number
                                                                                                                                          Spouse’s Social 
                                                                                         Spouse’s                                         Security  
                                                                                         Name                                             Number

                                                                                         Business
                                                                                         Name

                                                                                         Missouri Tax I.D.                                Federal Employer
                                                                                         Number                                           I.D. Number

                                                                                         Charter                                                           NAICS Code
                                                                                         Number                                                            (if applicable)
                               Tax Credit Claimant Information

                                                                                         Address                                          City                                               State  ZIP Code

                                                                                         Tax Type
                                                                                                           Individual Corporation     Other _____________________________________________________

                                                                                         Name

                                                                                         Address                                                      City                                   State      ZIP Code

                                                              Qualified Agency

                                                                                              CASA (Court Appointed Special Advocate) Child Advocacy Centers              Crisis Care Centers
                                                                              Agency Type

                                                                                                                      Contributions (See page two for additional contributions)

                                                                                         Date (MM/DD/YY)              Contribution Amount (Minimum amount $100)                Tax Credit (50%)
                                                                                                                      -- Round to nearest dollar --

__ __ / __ __ / __ __ __ __                                                                                                                                      00                                             00

__ __ / __ __ / __ __ __ __                                                                                                                                      00                                             00

__ __ / __ __ / __ __ __ __                                                                                                                                      00                                             00

                                                                                                                                                                                                            Page 1

                                                           Additional Contributions
                                                           Contribution Amount (Minimum amount $100)
               Date (MM/DD/YY)                                                                           Tax Credit (50%)
                                                           -- Round to nearest dollar --

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

 __ __ / __ __ / __ __ __ __                                                                  00                                                               00

               *Total                                                                         00                                                               00
*If needed, attach a separate sheet and include the total of all contributions here.

We are submitting this claim for the purpose of establishing the taxpayer’s eligibility for the tax credit pursuant to 
Section 135.341, RSMo            ,and said taxpayer is entitled to a tax credit of 50% of the contribution. Champion for Children tax 
credits are subject to available funding. If claims exceed the funding, the redemption of the credit will be prorated to the extent funds 
are available.

              I certify this claim to be true and accurate.
              Signature of Qualified Agency Director                                                         Date (MM/DD/YYYY)
                                                                                                      __ __ / __ __ / __ __ __ __ 
              Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I am aware of any 
              applicable reporting requirements of Section 135.805 RSMo and the penalty provisions of Section 135.810 RSMo.
              Taxpayer Signature                                        Taxpayer’s Printed Name                                              Date (MM/DD/YYYY) 
 Signature(s)                                                                                             __ __ / __ __ / __ __ __ __ 
              Spouse’s Signature (if applicable)                        Spouse’s Printed Name                                             Date (MM/DD/YYYY) 
                                                                                                          __ __ / __ __ / __ __ __ __ 
Pursuant to Section 105.1500, RSMo, the Department of Revenue is prohibited from requiring any entity exempt from federal income 
tax under Section 501(c) of the Internal Revenue Code, or any individual, to provide the Department with any list, record, register, 
registry, roll, roster, or other compilation of data of any kind that directly or indirectly identifies a person as a member, supporter,  
volunteer of, or donor of financial or nonfinancial support to, any entity exempt from federal income tax under Section 501(c) of the 
Internal Revenue Code. Nothing in this form should be read or understood as a requirement that you provide any such information. 
Notwithstanding any publication, webpage, form, instruction, regulation, or statement shared by the Department, you are not required 
to include such information on this form. If you encounter any technical difficulty in submitting this form without including information 
that you believe is protected by Section 105.1500, RSMo, feel free to contact the Department by email at  
corporate@dor.mo.gov or by phone at 573-751-4541.

               This form must be attached to the Miscellaneous Income Tax Credits (Form MO-TC), along with your tax return.
                                                                                                                              Form MO-CFC (Revised 12-2023)
Mail to:   Taxation Division                               E-mail:  taxcredit@dor.mo.gov 
                Income Tax                                 Visit https://dor.mo.gov/tax-credits/cfc.html for additional information.
                P.O. Box 27 
                Jefferson City, MO 65105-0027              Ever served on active duty in the United States Armed Forces?  
                                                           If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible 
 Phone:        (573) 751-3220                              military individuals. A list of all state agency resources and benefits can be found at 
 Fax:          (573) 522-8619                              veteranbenefits.mo.gov/state-benefits/.
                                                                                                                                                               Page 2

                                      Instructions

Purpose
Provides a tax credit for contributions made to a qualified agency as determined by the Department 
of Social Services.

Eligible Applicants
Any individual or corporation that has income tax due under Chapter 143, RSMo, excluding taxes 
withheld under Sections 143.191 to 143.265, RSMo, and that makes a contribution to a qualified 
agency.

How the Program Works
A Champion for Children Tax Credit may be claimed in an amount equal to fifty percent of a 
contribution made to a qualified agency. The minimum contribution amount is $100.

Carryforward and Non-refundable
Any amount of tax credit which exceeds the tax due may be carried forward to the next four 
subsequent years, not to exceed a total of five years. The CFC tax credit is not refundable and may 
not be assigned, transferred, or sold.

Procedures to Claim the Credit
To claim the Champion for Children Tax Credit, the taxpayer must attach Form MO-CFC or a copy of 
the contribution verification provided by the qualifying agency, to the income tax return along with a 
completed Form MO-TC.

Funding Limits and Due Date
Returns claiming the Champion for Children Tax Credit must be filed between July 1 through April 15 
of each fiscal year.
The cumulative amount of the tax credits redeemed shall not exceed a total of $1,000,000 for all  
fiscal years ending on or before June 30, 2019, and $1,500,000 for all fiscal years beginning on or 
after July 1, 2019. The amount available shall be equally divided among the three qualified agencies:
 • CASA
 • Child Advocacy Centers, or
 • Crisis Care Centers.
In the event the total amount of tax credits claimed exceeds the amount available, the amount 
redeemed will be apportioned equally to all eligible taxpayers claiming the credit for that agency.
If the credit amount redeemed is apportioned and reduced due to lack of available funds, the 
taxpayer will not be held liable for any penalty or interest, provided the balance is paid or approved 
payment arrangements have been made, within sixty days of notification. If the balance is not paid
within sixty days of notification, the remaining balance, including interest and penalties will be due 
and payable.

Authorization
This credit may be applied to the taxpayer’s individual income tax, corporation income tax, or any 
other tax incurred under the provisions of Chapter 143, RSMo, excluding state withholding tax.

                                                                                 Form MO-CFC (Revised 12-2023)