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                                                                          Missouri Department of Revenue                                    Department Use Only
                                                              Form        Food Pantry, Homeless Shelter, or                                 (MM/DD/YY)
                                                              MO-FPT      Soup Kitchen 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 _____________________________________________________

Food Pantry, Homeless Shelter, or Soup Kitchen Name

Food Pantry, Homeless Shelter, or Soup Kitchen Address                                                                     City                                            State ZIP Code

                                                              Any taxpayer who donates cash or food to a food pantry, homeless shelter, or soup kitchen unless such food is donated after the 
                                                              expiration date may claim a tax credit against the tax imposed by Chapter 143 RSMo. The credit granted shall equal 50% of the 
                                                              value of the contribution or donation made. Donations to a food bank, out-of-state food pantry, out-of-state homeless shelter or 
                                                              out-of-state soup kitchen do not qualify for the credit. Credits cannot exceed $2,500 per taxpayer per year, cannot exceed the 
                                                              taxpayer’s tax liability, and cannot be sold or transferred. All claims must be filed by April 15 of the fiscal year. If claims exceed 
Qualifications                                                $1.75 million, all claims will be apportioned equally among those filing a valid claim.

                                                              • If married individuals filing a combined return made             •  If you included any contributions as charitable donations on 
                                                                contributions to a food pantry, homeless shelter, or soup             your Federal Schedule A, and you claimed itemized 
                                                                kitchen each spouse may claim up to $2,500.                           deductions on your Missouri return, you must report those 
                                                              •   If you made contributions to more than one food pantry,             contributions on Form MO-A, Line 4. See Form MO-A  
                                                                homeless shelter, or soup kitchen you will need to complete a         instructions for further information.
                                                                separate Form MO-FPT for each food pantry, homeless shelter,  •  An eligible staff member of the food pantry, homeless shelter, 
                                                                or soup kitchen.                                                      or soup kitchen must certify that each contribution reported 
Instructions                                                  •  Enter the date and amount of each contribution in the                was received. 
                                                                appropriate columns below.                                       •  If your corporation, partnership, resident estate, or trust reduced 
                                                              •   Multiply each contribution amount by 50% and report the credit      its federal taxable income by charitable contributions to a food 
                                                                amount in the appropriate column.                                     pantry, homeless shelter, or soup kitchen you must report 
                                                              • Total all contributions and tax credit amounts from each column.      those amounts as additions onForm MO-1120,MO-1120S        , 
                                                              • Enter the tax credit amount.                                          MO-1065, or MO-1041.

Ever served on active duty in the United States Armed Forces?  
If yes, visit dor.mo.gov/military/ to see the services and benefits DOR offers to all eligible military 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/.

                       Date of Contribution (MM/DD/YYYY)                                       Contribution Amount                                   Tax Credit (50%)

                       Yourself                            Spouse                              Yourself       Spouse                         Yourself              Spouse

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

         Contributions ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                       ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___           00          00                               00                             00

                                             *Total                                                      00          00                               00                             00
                       *If needed, attach a separate sheet and include the total of all contributions here. Enter the total amount on Form MO-TC.

                       I certify the above contributions were made to the food pantry listed above and I am eligible to sign this document.
                       Signature of Staff Member                                                                                             Date (MM/DD/YYYY)
                                                                                                                                             ___ ___ / ___ ___ / ___ ___ ___ ___
                       Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.  (Spouse must sign if claiming a 
                       credit(s).) I am aware of any applicable reporting requirements of Section 135.805 RSMo and the penalty provisions of Section 135.810 RSMo. 
                       Signature of Taxpayer                                                                                                 Date (MM/DD/YYYY)
         Signature
                                                                                                                                             ___ ___ / ___ ___ / ___ ___ ___ ___
                       Signature of Spouse (if applicable)                                                                                   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 return.
                                                                                                                                                     Form MO-FPT  (Revised 12-2024)
                       Taxation Division                   Taxation Division                                Phone: (573) 751-3220  
                       Individual Income Tax               Business Tax                                     Fax: (573) 522-8619
                       P.O. Box 27                         P.O. Box 3365                                    E-mail:  taxcredit@dor.mo.gov    
                       Jefferson City, MO 65105-0027       Jefferson City, MO 65105-3365    
                                                            
                                                           Visit dor.mo.gov/taxcredit/fpt.php for additional information.