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Application for Tax credit


									                            APPLICATION FOR NON-RESIDENT TAX OFFSET CREDIT
                               University of Missouri - St. Louis
                                               Cashier's Office                                       (314) 516-5151
                                               285 Millennium Student Center                
                                               One University Blvd.
                                               St. Louis, MO 63121-4400

                              Credit For: SUMMER 2009        FALL 2009      SPRING 2010
                              Requires Tax Information from the tax year of    2008
                                                        Student's Information
Last Name                                      First Name                                             Middle Initial

Social Security Number                         Student Number

                                                       Taxpayer's Information
Last Name                                      First Name                                             Middle Initial

Social Security Number                         Email Address (Optional)

Mailing Address

City                                           State                       Zip                        Daytime Phone Number

                                                       REQUIRED DOCUMENTATION
       1. Missouri State income tax returns (MO-1040) for the tax year indicated at the top of the application, including the Non-
          Resident Schedule. If the student is not the taxpayer listed on the MO-1040, then the front page of your 1040 Federal Income
          Tax form that lists the student by name or Social Security Number can be used in conjunction with your MO-1040 to prove
          status as a dependent.
       2. All W2's, 1099's, or Schedules that indicate the source of the Missouri income for the tax year noted at the top of the
       3. A copy (front and back) of the canceled check to Missouri Department of Revenue for Missouri State Tax payments made. If
          paid by credit card, please provide a copy of your credit card statement detailing payments made. (if applicable)
       4. Copies of the above documentation will need to be submitted with the application. This information will not be returned. It
          is the students responsibility to obtain copies of the appropriate documentation. (This Cashier's office does not provide
          copy service.)
                                                         TERMS AND CONDITIONS
       1. The student must be listed by name as a dependent of the tax payer.
       2. The credit applied is based on taxes that were due and paid, not taxes withheld.
       3. Only taxes paid during the specified year can be applied towards the semesters indicated. A credit will be placed on your
          account for subsequent semesters until either the tax credit has been depleted or the semester no longer qualifies. The tax
          credit can not be carried forward beyond the semesters specified on this form.
       4. The taxpayer must have accrued a personal income tax liability in the year for which the tax off set credit originates.
       5. The tax credit can only offset against the Non-Resident Educational Fee. The total of the credit for the semesters can not be
          greater than the Missouri State Taxes paid in the tax year specified.
       6. This application must be completed and approved at least one week prior to a fee payment deadline. If you fail to do so you
          will be required to pay the full Non-Resident Educational Fee and will be reimbursed, if your application is approved.
       7. This application must be signed by both the Student and the Taxpayer. By signing this form you acknowledge and agree
          that the information on and submitted with this application can be discussed with either party. If a joint return is filed, both
          tax payer signatures are required.

         All information requirements and conditions of this credit are subject to change without notice. The Cashier's Office may
         need to request additional information before a credit is issued. The application must be approved by the Cashier's Office
         and should not be considered a contract.

                         Signature of Student               Date                    Signature of Tax Payer                   Date

                                                                                    Signature of Joint Filer                 Date

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