*235231*
2023 CRP, Certificate of Rent Paid
Renter/Unit Information

Renter First Name and Initial                     Renter Last Name                                         Electronic Certificate Number (ECN)

Rental Unit Address                                                Unit                                    Rented from (MM/DD/YYYY) to (MM/DD/YYYY) 

City                                    State     ZIP Code         County                                  Total Months Rented                                                                   Total Adults Living in Unit 

Property Information
Place an X if the property is: 

     (1) Adult Foster Care          (2) Assisted Living        (3) Intermediate Care Facility 
                                                                                                           Property ID or Parcel Number
     (4) Nursing Home               (5) Mobile Home            (6) Mobile Home Lot
                                                                                                           Number of Units on This Property

Rent Details
A. Was any rent paid by Medical Assistance (see instructions)?                                 (A) Yes  No If yes, enter amount: A    

B. Did the renter receive Minnesota Housing Support (formerly GRH)(see instructions)?          (B) Yes  No If yes, enter amount: B   

Total Rent
1  Renter’s share of rent paid (see instructions) . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . 1 

2  Caretaker rent reduction (see instructions)  . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . .  .  2 

3    Total rent (Add lines 1 and 2)  . . .  . . . . . .  . . . . .  . . . . . . .  . . . . .  . . . . . .  . . . . .  . . . . .  . . . . . .  . . . . . .  . . . . . .  . . . . .  . . . . . . 3 

Property Owner

Property Owner Name                                                                                        Daytime Phone

Property Owner Address                                             City                                    State ZIP Code

Sign Here
I declare that this certificate is correct and complete to the best of my knowledge and belief.

Owner or Agent Signature                                                                                   Date (MM/DD/YYYY) 

Managing Agent Name, If Applicable (please print)                                                          Daytime Phone 

Renter Instructions
Use this certificate to complete Form M1PR, Homestead Credit Refund (for Homeowners) and Renter’s Property Tax Refund. When you file Form M1PR, you 
must attach all CRPs used to determine your refund. Keep copies of Form M1PR and all CRPs for your records.

Note: The property owner or managing agent must give each renter living in a unit a separate CRP showing that they paid an equal portion of the rent, 
regardless of the portion actually paid.

For forms and tax-related information, go to our website at www.revenue.state.mn.us, or call 651-296-3781 or 1-800-652-9094. 

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