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Vermont Free Printable  for 2020 Vermont Homestead Declaration AND Property Tax Adjustment Claim

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Homestead Declaration AND Property Tax Adjustment Claim
Form HS-122, HI-144

Vermont Homestead Declaration AND Property Tax Adjustment Claim 2019 Form HS-122 DUE DATE: April 15, 2019. You may file up to Oct. 15, 2019, but the town may assess a penalty. For details on late filing, see the instructions. How to file a Homestead Declaration: Please complete Section A of this form, sign in the signature section at the bottom of page 2, and send the form to the Vermont Department of Taxes How to file a Property Tax Adjustment Claim: To be considered for a Property Tax Adjustment, you must file a 1) Homestead Declaration (Section A of this form), 2) Property Tax Adjustment Claim (Section B of this form), and 3) Schedule HI-144, Household Income. Sign this form in the signature section at the bottom of page 2 and send the forms to the Department. Tired of paper forms? It’s fast and convenient to file your claim online at www.myVTax.vermont.gov. Annual Vermont Homestead Declaration SECTION A. This form must be filed each year by every Vermont resident whose property meets the definition of a homestead. A Vermont homestead is the principal dwelling and parcel of land surrounding the dwelling, owned and occupied by a resident individual as the individual’s domicile on April 1. If your homestead is leased to a tenant on April 1, you may still claim it as a homestead if it is not leased for more than 182 days in the 2019 calendar year. Please PRINT in BLUE or BLACK INK Claimant’s Last Name First Name MI Claimant’s Social Security Number Spouse’s or CU Partner’s Last Name First Name MI Spouse’s or CU Partner’s Social Security Number Mailing Address Claimant’s Date of Birth (MMDDYYYY) City State ZIP Code Location of Homestead (Use a number, street/road name. Do not use a PO Box or “same.”) A2. City/Town of Legal Residence on April 1, 2019 State Federal Filing Status (Single=S; Head of Household=H; Joint=J; Separate=P) A3. SPAN Number - REQUIRED (From the 2018/2019 property tax bill) A4. Business Use of Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A4 % A5. Rental Use of Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A5 % A6. Business or Rental Use of Improvements or Other Buildings Not including the dwelling, are improvements or other buildings located on your parcel used for business or rented? . . . . . A7-A10 Special Situations (see instructions for more information). Check the following if it applies: Yes No A7. Grantor and sole beneficiary of a revocable trust owning the property A9. Homestead property crosses town boundaries (File a declaration for each town.) A8. Life estate holder of the property A10. Residing in a dwelling on the homestead parcel owned by a related farmer. *1912211WW* Mail to: Vermont Department of Taxes PO Box 1881 Montpelier, VT 05601-1881 * 1 9 1 2 2 1 1 W W * Page 1 of 2 Form HS-122 Rev. 10/18 Taxpayer’s Last Name DUE DATE: Social Security Number *1912212WW* * 1 9 1 2 2 1 2 W W * April 15, 2019. Claims accepted up to Oct. 15, 2019 SECTION B. PROPERTY TAX ADJUSTMENT CLAIM For Household Income up to $136,500. Complete and attach Schedule HI-144. To qualify, you must meet the requirements for filing a homestead declaration in addition to the following requirements. ALL eligibility questions must be answered. B1. Were you domiciled in Vermont all of calendar year 2018? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes, Go to Line B2 No, STOP B2. Were you claimed as a dependent in 2018 by another taxpayer? . . . . . . . . . . . . . . . . . . . . . Yes, STOP No, Go to Line B3. B3. Do you anticipate selling this Vermont housesite on or before April 1, 2019? . . . . . . . . . . . . Yes, STOP No, Continue Amounts for Lines B4-B6 are found on the 2018/2019 property tax bill. Round amounts to the nearest dollar. B4. Housesite Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B4 .00 B5. Housesite Education Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B5 .00 B6. Housesite Municipal Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B6 .00 B7. Ownership Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B7 % B8. Household Income (Schedule HI-144, Line y). You MUST attach Schedule HI-144 . . . . . . . . . . . B8 .00 B10. Mobile Home Lot Rent (Allocable Rent from Form LC-142 - include Form LC-142 with claim.). . . B10 OR Allocated Property Tax from Land Trust, Cooperative, or Nonprofit Mobile Home Park B11. Allocated Education Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 B11 .00 B12 OR Property Tax from contiguous property if housesite has less than 2 acres (see instructions.) B13. Contiguous property Education Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B13 .00 B14. Contiguous property Municipal Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 B8a. If Amended Schedule HI-144, Household Income, is included, check here: Complete the following ONLY if applicable. See instructions for details. Lot Rent B9. E-file Certificate Number (From Form LC-142). . . . . . . . . . . B9 B12. Allocated Municipal Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 B14 MAXIMUM ADJUSTMENT AMOUNT IS $8,000 Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Preparers cannot use return information for purposes other than preparing returns. Signature Date Telephone Number Signature (If a joint return, BOTH must sign.) Date Telephone Number Preparer’s SSN or PTIN Telephone Number Preparer’s Signature Date Firm’s Name (or your name if self-employed) and address EIN May the Department of Taxes contact your preparer? YES Page 2 of 2 Clear ALL fields Save and go to Important Printing Instructions Form HS-122 Rev. 10/18 Save and Print Vermont Household Income 2018 Schedule HI-144 Please PRINT in BLUE or BLACK INK For the year Jan. 1-Dec. 31, 2018 This schedule must be included with the 2018 Renter Rebate Claim (Form PR-141) OR the 2019 Property Tax Adjustment Claim (Form HS-122) UNLESS you are filing an AMENDED HI-144. Please read instructions before completing schedule. Claimant’s Last Name First Name MI Claimant’s Social Security Number Spouse’s or CU Partner’s Last Name First Name MI Claimant’s Date of Birth List the names and Social Security Numbers of all other persons (in addition to a Spouse or CU Partner) who had income and lived with you during 2018. Include both their taxable and non-taxable income in Column 3. If you have more than two “Other Persons” living in your household, record the names and Social Security Numbers on a separate sheet of paper and include with the filing. Other Person #1 Last Name First Name MI Other Person #1 Social Security Number Other Person #2 Last Name First Name MI Other Person #2 Social Security Number Yearly totals of ALL members of the household 1. Claimant and jointly filed Spouse 2. Filing separately Spouse or CU Partner 3. Other Persons a. Cash public assistance and relief . . . . . . . . . . . . . . . . . a .00 a .00 a b. Social Security, SSI, disability, railroad retirement, veteran’s benefits, taxable and nontaxable. . . . . . . . . . .00 b .00 b .00 b .00 c. Unemployment compensation/worker’s compensation. c .00 c .00 c d. Wages, Salaries, tips, etc. (See instructions for dependent’s exempt income.). . . . . . . . . . . . . . . . . . . . .00 d .00 d .00 d .00 e. Interest and dividends. . . . . . . . . . . . . . . . . . . . . . . . . . e .00 e .00 e f. Interest on U.S., state, and municipal obligations, taxable and nontaxable. . . . . . . . . . . . . . . . . . . . . . . . . .00 f .00 f .00 f .00 g. Alimony, support money, child support, cash gifts. . . . . g .00 g .00 g h. Business income. If the amount is a loss, enter -0-, See instructions for offsetting a loss . . . . . . . . . . . . . . . .00 h .00 h .00 h i. Capital gains, taxable and nontaxable. If the amount is a loss, enter -0-, See instructions for offsetting a loss . .00 i .00 i .00 i j. Taxable pensions, annuities, IRA and other retirement fund and distributions. See Instructions . . . . . . . . . . . . .00 j .00 j .00 j .00 k .00 k .00 k .00 l .00 l .00 l .00 m .00 m .00 m .00 n .00 n .00 n .00 k. Rental and royalty income. If the amount is a loss, enter -0-. See instructions for offsetting a loss. . . . . . . l. Farm/partnerships/S corporations/LLC/Estate or Trust income. If the amount is a loss, enter -0-. See Line I instructions for only exception to offset a loss. . . . . . . . m. Other income (see instructions for examples of other income). . . . . . . . . . . . . . . . . . . . Please Specify______________________________ n. Total Income: Add Lines a through m. . . . . . . . . . . . . . *1814411WW* * 1 8 1 4 4 1 1 W W * Page 1 of 2 Schedule HI-144 Rev. 10/18 Taxpayer’s Last Name o. See instructions. Enter Social Security and Medicare tax withheld on wages claimed on Line d. Self-Employed: Enter self-employment tax from Federal Schedule SE. This entry may differ from W-2/1099 or Federal Schedule SE amount if these taxes are paid on income not required to be reported on Schedule HI-144. Include W-2 and/or Federal Schedule SE if not included with income tax filing. . . . . . . . . . . . . . . . . . . . . . . . . . . p. Child support paid. You must include proof of payment. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Social Security Number 1. Claimant and jointly filed Spouse o 2. Filing separately Spouse or CU Partner o .00 p Support paid to: Last Name 3. Other Persons .00 o .00 .00 p First Name .00 p .00 MI Social Security Number q. Allowable adjustments from Federal Form 1040 q1. Business expenses for Reservists . . . . . . . . . . . . . q1 .00 q1 .00 q1 .00 q2. Alimony paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q2 .00 q2 .00 q2 .00 q3. Tuition and fees . . . . . . . . . . . . . . . . . . . . . . . . . . . q3 .00 q3 .00 q3 .00 q4. Self-employed health insurance deduction. . . . . . . q4 .00 q4 .00 q4 .00 q5. Health Savings Account deduction. . . . . . . . . . . . . q5 .00 q5 .00 q5 r. Add Lines o, p, and total of Lines q1 to q5 for each column. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .00 r .00 r .00 r s. Subtract Line r from Line n of each column. If a negative amount, enter -0- .. . . . . . . . . . . . . . . . . . . .00 s .00 s .00 s .00 t. Add all three amounts from Line s. If a negative amount, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t u. Complete if born Jan 1, 1954 and after. Enter interest and dividend income from Lines e and f. .00 u .00 v. Add all three amounts from Line u. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v .00 w. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w 10 000 .00 x. Subtract Line w from Line v. If Line w is more than Line v, enter -0- .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x .00 y. HOUSEHOLD INCOME. Add Line t and Line x. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y .00 u .00 u .00 RENTERS If Line y Household Income is $47,000 or less, you may be eligible for a renter rebate. Complete Form PR-141 Renter Rebate Claim. This schedule must be filed with the Renter Rebate Claim. Claims are due April 15, 2019, but can be filed up to Oct. 15, 2019. If Household Income is more than $47,000, you do not qualify for a renter rebate. HOMEOWNERS Form HS-122, Homestead Declaration AND Property Tax Adjustment Claim, must be filed each year. Homeowners with Household Income up to $136,500 on Line y should complete Form HS-122, Section B. You may be eligible for a property tax adjustment. This schedule must be filed with Form HS-122. Form HS-122 The due date to file is April 15, 2019. Homeowners filing a property tax adjustment, Form HS-122 and Schedule HI-144, between April 16 and Oct. 15, 2019, may still qualify for a property tax adjustment. A $15 late filing fee will be deducted from the adjustment. *1814412WW* * 1 8 1 4 4 1 2 W W * Page 2 of 2 Schedule HI-144 Rev. 10/18
Extracted from PDF file 2019-vermont-form-hs-122-hi-144.pdf, last modified January 2019

More about the Vermont Form HS-122, HI-144 Other TY 2019

Form HS-122, HI-144 requires you to list multiple forms of income, such as wages, interest, or alimony .

We last updated the Homestead Declaration AND Property Tax Adjustment Claim in January 2019, so this is the latest version of Form HS-122, HI-144, fully updated for tax year 2019. You can download or print current or past-year PDFs of Form HS-122, HI-144 directly from TaxFormFinder. You can print other Vermont tax forms here.

Related Vermont Other Forms:

TaxFormFinder has an additional 51 Vermont income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Vermont Form HS-122, HI-144.

Form Code Form Name
Form HS-122W Vermont Homestead Declaration and/or Property Tax Adjustment Withdrawal

Download all VT tax forms View all 52 Vermont Income Tax Forms


Form Sources:

Vermont usually releases forms for the current tax year between January and April. We last updated Vermont Form HS-122, HI-144 from the Department of Taxes in January 2019.

Show Sources >

Historical Past-Year Versions of Vermont Form HS-122, HI-144

We have a total of five past-year versions of Form HS-122, HI-144 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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