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Michigan Department of Treasury (Rev. 12-21), Page 1 of 2 
                                                                                                                                                    Attachment 08 

2021 MICHIGAN Home Heating Credit Claim MI-1040CR-7                                                                                      Amended Return 
Issued under authority of Public Act 281 of 1967, as amended. Type or print in blue or black ink. 
1. Filer’s First Name                         M.I.        Last Name                                           2. Filer’s Full Social Security No. (Example: 123-45-6789) 

If a Joint Return, Spouse’s First Name        M.I.        Last Name 
                                                                                                              3. Spouse’s Full Social Security No. (Example: 123-45-6789) 
Home Address (Number, Street, or P.O. Box) 

City or Town                                                        State    ZIP Code                         4. County Code (see instructions) 

5. Citizenship Status                                                                                         6. Heat Provider Name Code (see instructions) 

a.   Filer is a U.S. citizen               b.             Spouse is a U.S. citizen                            7.  Heat Type Code (see instructions) 
     or qualified alien                                   or qualified alien 

8.  2021 FILING STATUS:                    9.  2021 RESIDENCY STATUS:                                  *If you checked box “c,” enter dates of Michigan residency in 2021.
    Check one.                                 Check all that apply.                                   Enter dates as MM-DD-YYYY (Example: 04-15-2021). 
                                                                                                                    FILER                           SPOUSE 
a.      Single                             a.             Resident                                                                 2021                                 2021
                                                                                                    FROM: 
b.      Married filing jointly             b.             Nonresident                                                              2021                                 2021
                                                                                                    TO: 
c.      Married filing separately          c.             Part-Year Resident* 
        (Include Form 5049) 
                                                                                                          16. Exemptions. Enter the number that applies to you, 
10.  Check the box if your   heating costs are currently included in your                                     your spouse, or your dependents and complete line             17 
    rent (see instructions)........................................................................ 
                                                                                                              below. See instructions if you are age 66 or older. 

11.  Check the box if you want to be referred to other government                                             Personal Exemption
    assistance programs for which you may qualify............................                                 (You and your spouse only) ..........................  a. 

12.  Check the box if you or your spouse now receive                                                          Deaf, Disabled or Blind ...................  b. 
    Supplemental Security Income (SSI)........................................ 
                                                                                                              Qualified Disabled Veteran  ............               c. 
                                                                    Filer    Spouse 
                                                                                                              Number of children living with you: 
13.  ENTER YOUR AGE if you are age 60 or older...                                                             = Ages 2 and under  .......................  d. 

                                                                                                              =
14.  Amount you were billed for                                                                                 Ages 3-5......................................  e. 
    heat between 11/1/2020 and 10/31/2021                 .........                                 00 
15.  If you lived in one of these CARE facilities (not a senior apartment                                     = Ages 6-18....................................        f. 
    complex) for all of 2021, check the box and STOP here, see instructions. 
                                                                                                              Dependent adults, other than 
     a.      Nursing Home                                 b.        Adult Foster Care Home                    your spouse, who live with you.......           g. 

     c.      Licensed Home for the Aged                   d.        Substance Abuse Center                    Add lines 16a through 16g..............  h. 
17.  You MUST enter below the name, Social Security number and age of all household members (except for filer and spouse from line 1). 
     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 

   If you have more than four (4) household members, complete Home Heating Credit Claim MI-1040CR-7 Supplemental (Form 4976). 

                                              18.                   You must check this box to receive a refund from your heat provider for 
                                                                    any overpayment to your heat account, if eligible (see instructions).
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2021 MI-1040CR-7, Page 2 of 2 
                                                              Filer’s Full Social Security Number 
TOTAL HOUSEHOLD RESOURCES. If filing a joint return, include income from both spouses.  If married filing 
separately, you must include Form 5049 available on Treasury’s Web site. 
19.  Wages, salaries, tips, sick, strike                                            26.  Social Security, SSI, and/or 
      and SUB pay, etc............................  19.                          00           railroad retirement benefits  ....  26.                             00 
20.  All interest and dividend income                                               27.  Child support and foster 
      (including nontaxable interest)........  20.                               00           parent payments....................                     27.         00 
21.   Net business income (including net                                            28.  Unemployment 
      farm income). If negative, enter “0” ..          21.                       00           compensation ........................  28.                          00 
22.  Net royalty or rent income. If                                                 29.  Gifts received or expenses 
      negative, enter “0”  ........................  22.                         00           paid on your behalf  ................  29.                          00 
23.  Retirement pension, annuity, and                                               30.  Other nontaxable income. 
      IRA benefits.  ...................................  23.                    00           Describe:_______________  30.                                       00 
24.  Capital gains less capital losses                                              31.       Workers’/veterans’ disability 
      (see instructions) ............................  24.                       00           compensation/pension benefits ...                       31.         00 
25.  Alimony and other taxable income.                                              32.       FIP and other MDHHS benefits 
      Describe:____________________  25.                                         00           (Do not include food assistance)                        32.         00 
33.  Add lines 19 through 32.....................................................................................................SUBTOTAL             33.         00
34.   Other adjustments.  
      Describe:________________________________________________                                 34.                              00

35.  Medical insurance or HMO premiums paid  ..........................................         35.                              00 
36.  Add lines 34 and 35............................................................................................................................. 36.         00 

37.  Subtract line 36 from line 33.............................................. TOTAL HOUSEHOLD RESOURCES.                                           37.         00 

Standard and Alternate Home Heating Credit Computations 
38.   STANDARD  CREDIT. Standard allowance from Table A (see instr.)  .....  38.                                                 00 
39.   Multiply line 37 by 3.5% (0.035) (if negative, enter “0”) ............................    39.                              00 
40.  Subtract line 39 from line 38 for standard credit amount. If line 39 is 
      greater than line 38, enter “0”  ..................................................................  40.                   00 
41.  If you checked the box on line 10, multiply the amount on line 40 by 50% (0.50). Enter here 
      and on line 46. (If approved, the final amount as shown on line 47 is issued as a check.)  ................                                     41.         00 
42.   ALTERNATE CREDIT.  Total heating costs from 
      line 14 or $3,047 (whichever is less) .................................................   42.                              00 
43.   Multiply line 37 by 11% (0.11) (if negative, enter “0”)  .........................        43.                              00 
44.  Subtract line 43 from line 42. If line 43 is greater than line 42, enter “0”  .  44.                                        00 
45.  Multiply line 44 by 70% (0.70) for alternate credit amount  ......................  45.                                     00 
46.  If you completed line 41 enter that amount here. Otherwise enter the larger of lines 40 or 45 here..                                             46.         00 

47.   HOME HEATING CREDIT. Multiply line 46 by 100% (1.00) ............................................................                               47.         00 
Deceased Taxpayer.     If Filer and/or Spouse died after December 31, 2020, enter dates below.Preparer Certification.   I declare under penalty of perjury that this 
ENTER DATE OF DEATH ONLY. Example: 04-15-2021 (MM-DD-YYYY)                                      return is based on all information of which I have any knowledge. 
                                                                                                Preparer’s  PTIN, FEIN or SSN 
Filer                                  Spouse 
Taxpayer Certification.  I declare under penalty of perjury that the information in this return Preparer’s Name (print or type) 
and attachments is true and complete to the best of my knowledge. 
Filer’s Signature                                                 Date                          Preparer’s Signature 

Spouse’s Signature                                                Date                          Preparer’s Business Name, Address and Telephone Number 

      By checking this box, I authorize Treasury to discuss my return with my preparer. 

File (postmark) your claim by September 30, 2022.  Mail your claim to:  Michigan Department of Treasury 
                                                                                                Lansing, MI  48956 

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