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                            Form
MO-PTC                                 2023 Property Tax Credit Claim

Print in BLACK ink only and DO NOT STAPLE.
For Privacy Notice, see Instructions.

                            Select Here for Amended Claim

                            Department of Social Services Application of Eligibility            Vendor Code                     Department Use Only
                            form attached
                                                                                                0 0 1
                                                                                     Deceased                                    Deceased
                            Social Security Number                                   in 2023    Spouse’s Social Security Number                    in 2023

                                         -             -                                        -                       -
                            Birthdate (MM/DD/YYYY)                                              Spouse’s Birthdate (MM/DD/YYYY)

                            First Name                     M.I.              Last Name                                                             Suffix
       Name

                            Spouse’s First Name            M.I.              Spouse’s Last Name                                                    Suffix

                            In Care Of Name (Attorney, Executor, Personal Representative, etc.)

                            Present Address (Include Apartment Number or Rural Route)

                            City, Town, or Post Office                                          State                   ZIP Code
                                                                                                                                _
       Address
                            County of Residence

                            Select only one qualification. Copies of letters, forms, etc., must be included with claim. 

                                A.  65 years of age or older - You must be a full year resident. (Attach Form SSA-1099.)

                                B.  100% Disabled Veteran as a result of military service (Attach letter from Department of Veterans Affairs - see instructions.)

       Qualifications           C.  100% Disabled (Attach letter from Social Security Administration or Form SSA-1099.)

                                D.  60 years of age or older and received surviving spouse benefits (Attach Form SSA-1099.)

                            Select only one filing status. If married filing combined, you must report both incomes. 
  Filing              Status
                                Single             Married - Filing Combined         Married - Living Separate for Entire Year

                                                           *23344010001*
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Failure to provide the following attachments will result in denial or delay of your claim:
Verification of Rent Paid (Form 5674), Form(s) 1099, W-2, etc.

1. Enter the amount of social security benefits received by you, your spouse, and your minor
children before any deductions and the amount of social security equivalent railroad retirement
benefits. Attach Form(s) SSA-1099 or RRB-1099 (TIER I) ............................. 1 . 00
2. Enter the total amount of wages, pensions, annuities, dividends, interest income, rental income,
unemployment compensation, or other income. Attach Form(s) W-2, 1099, 1099-G, 1099-R,
1099-DIV, 1099-INT, 1099-MISC, etc. ............................................. 2 . 00

3. Enter the amount of railroad retirement benefits (not included in Line 1) before any deductions.
Attach Form RRB-1099-R (TIER II) ............................................... 3 . 00

4. Enter the amount of veteran’s payments or benefits before any deductions.
Attach letter from Veterans Affairs (see instructions on page 5) ......................... 4 . 00

5. Enter the total amount received by you, your spouse, and your minor children from: public
assistance, Supplemental Security Income (SSI), child support, or Temporary Assistance
payments (TA and TANF). Attach a letter from the Social Security Administration that includes
the amount of assistance received if applicable ...................................... 5 . 00

6. Total household income - Add Lines 1 through 5 and enter the total here .................... 6 . 00

Household Income
7. Enter the appropriate amount from the options below .................................. 7 . 00

• Single or Married Living Separate - Enter $0

• Married and Filing Combined - rented or did not own your home for the entire year - Enter $2,000

• Married and Filing Combined - owned and occupied your home for the entire year - Enter $4,000

8. Net household income - Subtract Line 7 from Line 6 and enter the amount here ............. 8 . 00

• If you rented or did not own and occupy your home for the entire year and Line 8 is
greater than $27,200, you are not eligible to file this claim.

• If you owned and occupied your home for the entire year and Line 8 is greater
than $30,000, you are not eligible to file this claim.

9. If you owned your home, enter the total amount of property tax paid for your home, minus special
assessments, or $1,100, whichever is less. Attach a copy of your 2023 paid real estate tax
receipt(s). If your home is on more than five acres or you own a mobile home, attach the
Assessor’s Certification (Form 948).................................................. 9 . 00

10. If you rented, enter the total amount from Certification of Rent Paid (Form MO-CRP) Line 9 or
$750, whichever is less. Attach a completed Verification of Rent Paid (Form 5674). NOTE: If you
rent from a facility that does not pay property tax, you are not eligible for a Property Tax Credit.. 10 . 00

Real Estate Tax and Rent Paid 11. Enter the total of Lines 9 and 10, or $1,100, whichever is less ............................. 11 . 00

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   12.  Apply amounts from Lines 8 and 11 to chart on pages 14-16 to figure your Property Tax Credit. 
              You must use the chart on pages 14-16 to see how much refund you are allowed. ............          12                       . 00

                                           Reserved 

            Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to 
            the best of my knowledge and belief it is true, correct, and complete. By signing or entering my name in the “Signature” field(s) 
            below, I am providing the Department of Revenue with my signature as required under Section 143.561, RSMo. Declaration of 
            preparer (other than taxpayer) is based on all information of which he or she has any knowledge. As provided in Chapter 143, 
            RSMo, a penalty of up to $500 shall be imposed  on any individual who files a frivolous return. I also declare under penalties of
            perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption, 
            credit, or abatement if I employ such aliens. I further affirm that I am aware of the reporting requirements of Section 135.805 and 
the   penalty provisions of Section 135.810.
            Signature                                                                           Date (MM/DD/YY)

            Spouse’s Signature (If filing combined, BOTH must sign)                             Date (MM/DD/YY)

            E-mail Address                                                                      Daytime Telephone

  Signature Preparer’s Signature                                                                Date (MM/DD/YY)

            Preparer’s FEIN, SSN, or PTIN                                                       Preparer’s Telephone

            Preparer’s Address                                                                  State                      ZIP Code

            I authorize the Director of Revenue or delegate to discuss my claim and attachments with the preparer 
            or any member of his or her firm, or if internally prepared, any member of the internal staff.............       Yes           No

            Did you pay a tax return preparer to complete your return, but the preparer failed to sign the return or provide 
            an Internal Revenue Service preparer tax identification number?  If you marked yes, please insert the 
            preparer’s name, address, and phone number in the applicable sections of the signature block above.....          Yes           No

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                                                                    Department Use Only

            A              K               R                        U

                                                                                                                             Form MO-PTC (Revised 12-2023)
Mail to:   Taxation Division                 E-mail:   Incometaxprocessing@dor.mo.gov (Submit Property Tax Claim)  
                P.O. Box 2800                E-mail:  PropertyTaxCredit@dor.mo.gov (Inquiry and correspondence)
                Jefferson City, MO 65105-2800
                                             Ever served on active duty in the United States Armed Forces?  
 Phone:        (573) 751-3505                If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all eligible 
  Fax:         (573) 522-1762                military individuals. A list of all state agency resources and benefits can be found at 
  TTY:   (800) 735-2966                      veteranbenefits.mo.gov/state-benefits/.
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One Form MO-CRP must be provided for each rental location in which you resided.
Form Failure to provide landlord information will result in denial or delay of your claim.
MO-CRP 2023 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) 2023 (MM/DD/YY) 2023

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

*23315010001*
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For Privacy Notice, see instructions. Form MO-CRP (Revised 12-2023)
Ever served on active duty in the United States Armed Forces?
Taxation Division If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all
Attach to Form MO-PTC or MO-PTS and eligible military individuals. A list of all state agency resources and benefits can be
mail to the Missouri Department of Revenue. found at veteranbenefits.mo.gov/state-benefits/.

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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) 2023 (MM/DD/YY) 2023

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

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                                                                                                                   Department Use Only
                                                  Form                                                             (MM/DD/YY)

5674                                                   Verification of Rent Paid

                                                                                 Landlord must complete this form each year. 
                                                                                                                                                                                                          Tax Year
                                                  Tenant’s Name                                                    Social Security Number

                                                                                                                                      -                                                                   -
                                                  Rental Address

                                                  City                                         State                                                                                                                      ZIP Code

                                                  Rental Begin Date (MM/DD/YYYY) Rental End Date (MM/DD/YYYY)

                                                  Gross Rent Paid for the Year  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                          . 00

                    Tenant and Rental Information Did the tenant receive any housing assistance?   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . Yes     No

                                                  If yes, how much rent was the tenant responsible for?   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .                                             . 00

                                                  Did anyone reside at this dwelling with the above tenant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .      Yes     No

                                                  If yes, how many were over the age of 18?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .

                                                  Landlord’s Name

                                                  Landlord’s Address

                                                  City                                         State                                                                                                                      ZIP Code

                                                  Telephone Number (Home)                      Telephone Number (Cell)
                    Landlord Information

                                                  Telephone Number (Work)                      Landlord’s Signature

                                                                                                                                                                                                                          Form 5674 (Revised 12-2023)

Taxation Division                                                                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 
Attach to Form MO-PTC or MO-PTS and                                              military individuals. A list of all state agency resources and benefits can be found at 
mail to the Missouri Department of Revenue .                                     veteranbenefits.mo.gov/state-benefits/ .

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