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D Public Safety Officer Surviving Spouse Credit) LAST NAME FIRST NAME INITIAL SOCIAL SECURITY NO. SPOUSE S LAST NAME FIRST NAME INITIAL SPOUSE S SOCIAL SECURITY NO. ADDRESS CITY STATE ZIP CODE HOMESTEAD TAXES TO THE CLAIMANT: If your real estate tax receipt on your homestead includes tax on your dwelling and surrounding land which exceeds five (5) acres, the county assessor must complete this section to determine the appropriate percentage you may claim on Form MO-PTC, Form MO-P.

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