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2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 3 3 4 NEAR FINAL DRAFT 8/23/21 4 5 5 *211451* 6 6 7 2021 Schedule M1CAT, Casualty and Theft 7 8 Do not complete Schedule M1CAT if you completed federal Form 4684 to report a net gain from a casualty or theft on your federal income tax return. 8 9 9 10 112233333 10 FIRSTYour First Name NAME, and Initial INITXXXXX LastYOUR Name LAST NAMEXXXXXXXXXXXXXXXXXXXX Social Security Number 11 11 12 1 Description of properties, including the type, location, and date acquired for each property. Use a separate line for each property lost or damaged 12 13 from the same casualty or theft event. You must file a separate Schedule M1CAT for each casualty or theft event involving personal property. 13 14 14 15 Property A PROPERTY A DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 15 16 16 Property B 17 PROPERTY B DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 17 18 18 Property C 19 PROPERTY C DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 19 20 20 Property D 21 PROPERTY D DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 21 22 22 23 Property A Property B Property C Property D 23 24 24 25 2 Cost or other basis (see instructions) ...... 2 123456789123456789123456789 12345678 25 26 3 Insurance or other reimbursement, whether or not you filed a claim 26 27 (see instructions) Note: If line 2 is more than line 3, skip line 4 . . . 3 12345678 12345678 12345678 12345678 27 28 4 Gain from casualty or theft. Subtract line 2 from 28 29 line 3 and skip lines 5 through 9 for that column ...... 4 12345678 12345678 12345678 12345678 29 30 30 31 5 Fair market value before casualty or theft ...... 5 12345678 12345678 12345678 12345678 31 32 32 33 6 Fair market value after casualty or theft ...... 6 12345678 12345678 12345678 12345678 33 34 34 35 7 Subtract line 6 from line 5 ...... 7 12345678 12345678 12345678 12345678 35 36 36 37 8 Enter the smaller of line 2 or line 7 ...... 8 1234678 1234678 1234678 12345678 37 38 38 39 9 Subtract line 3 from line 8. If zero or less, enter 0 ...... 9 12345678 12345678 12345678 12345678 39 40 40 41 10 Casualty or theft loss. Add the amounts on line 9 for Properties A through D ...... 10 12345678 41 42 (see instructions if you are filing multiple schedules for the same event) 42 43 11 Enter $100 ...... 11 $100 43 44 44 45 12 See instructions before completing line 12. Subtract line 11 from line 10. If zero or less, enter 0...... 12 12345678 45 46 13 If you had one casualty or theft event, enter the amount from line 12 46 47 If you had more than one event, see instructions ...... 13 12345678 47 48 48 49 14 Add the amounts on line 4 of all Schedules M1CAT you are filing ...... 14 12345678 49 50 15 If line 14 is greater than or equal to line 13, enter the difference here.STOP HERE and see instructions. 50 51 If line 14 is less than line 13, enter 0 here and continue to line 16 ...... 15 12345678 51 52 52 53 16 Add lines 14 and 15...... 16 12345678 53 54 54 55 17 Subtract line 16 from line 13 ...... 17. 12345678 55 56 56 57 18 Enter the amount from line 1 of Form M1 or line 37 of Schedule M1NC ...... 18 12345678 57 58 58 59 19 Multiply line 18 by 10% (.10) ...... 19 12345678 59 60 60 61 20 Subtract line 19 from line 17. If the result is zero or less, enter 0. Enter the result on line 19 of Schedule M1SA . . .20 12345678 61 62 62 63 9995 63 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86

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