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Michigan Department of Treasury 
4976 (Rev. 05-21) 

2021 MICHIGAN Home Heating Credit Claim MI-1040CR-7 Supplemental 
Issued under authority of Public Act 281 of 1967, as amended. 
INSTRUCTIONS: Complete if you have more than four (4) household members and include with your Form MI-1040CR-7. 
Type or print in blue or black ink.                                                               Attachment 08A 
1. Filer’s First Name               M.I.                      Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789) 

3. You MUST enter below the name, Social Security number and age of all household members (except for filer and spouse)  who are not 
   already listed on MI-1040CR-7, line 17. You MUST also check each box to indicate if the household member is a dependent and  
   U.S. citizen or qualified alien. 
                                                                                        D. Enter “X” for all that apply 
   A. Household Member’s Name       B. Social Security Number           C. Age in Years Dependent U.S. citizen or qualified alien 

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