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Vermont Free Printable  for 2021 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 Department of Taxes *211221100* 2021 Form HS-122 Vermont Homestead Declaration AND Property Tax Credit Claim * 2 1 1 2 2 1 1 0 0 * DUE DATE: April 15, 2021. You may file up to Oct. 15, 2021, 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 Credit Claim: To be considered for a Property Tax Credit, you must file a 1) Homestead Declaration (Section A of this form), 2) Property Tax Credit 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 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, 2021. If your homestead is leased to a tenant on April 1, 2021, you may still claim it as a homestead if it is not leased for more than 182 days in the 2021 calendar year. Please PRINT in BLUE or BLACK INK Claimant’s Last Name First Name MI Claimant’s Social Security Number Spouse’s/CU Partner’s Last Name First Name MI Spouse’s or CU Partner’s Social Security Number Mailing Address (Number and Street/Road or PO Box) Claimant’s Date of Birth (MMDDYYYY) City SPAN - REQUIRED (from the 2020/2021 property tax bill) State ZIP Code Location of Homestead (Use a number, street/road name. Do not use a PO Box or “same.”) Federal Filing Status A1. Single Married/CU Filing Jointly / / City/Town of Legal Residence on April 1, 2021 Married/CU Filing Separately & State Head of Household Business Use of Dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A1. ___________________ % A2. Rental Use of Dwelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A2. ___________________ % A3. 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?. . . . A3. Yes A4-A7 Special Situations (see instructions for more information). Check the following if it applies: A4. Grantor and sole beneficiary of a revocable trust owning the property Homestead property crosses town boundaries (File a declaration for each town.) Residing in a dwelling on the homestead A7. parcel owned by a related farmer. A6. A5. Life estate holder of the property Please continue to Page 2, Part B, for property tax credit. Sign on Page 2. Mail to: Vermont Department of Taxes PO Box 1881 Montpelier, VT 05601-1881 5454 Page 1 of 2 Form HS-122 Rev. 10/20 No Claimant’s Last Name DUE DATE: Social Security Number *211221200* * 2 1 1 2 2 1 2 0 0 * April 15, 2021. Claims accepted up to Oct. 15, 2021. SECTION B. PROPERTY TAX CREDIT CLAIM For Household Income up to $138,500. 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 2020? . . . . . . . . Yes, Go to Line B2. No, STOP. B2. Were you claimed as a dependent in 2020 by another taxpayer?. . . . . Yes, STOP. No, Go to Line B3. B3. Do you anticipate selling this Vermont housesite on or before April 1, 2021? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes, STOP. No, Continue Amounts for Lines B4-B6 are found on the 2020/2021 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 z). You MUST attach Schedule HI-144. . . . . . . . . . . . . . . . . . . . . . . . . . . . . B8. ______________________ .00 % Check here if amended Schedule HI-144, Household Income, is included. Complete the following ONLY if applicable. See instructions for details. B9. E-file Certificate Number (from Form LC-142). . . . . . . . . . . . . . . . . . . . . . . . B9. ________________________________________________________ B10. Lot Rent (Allocable Rent from Form LC-142 - include Form LC-142 with claim.). . . . . . . . . . . . . . . . . . B10. __________________________.00 Attach documentation for Allocated Property Tax from Land Trust, Cooperative, or Nonprofit Mobile Home Park B11. Allocated Education Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B11. __________________________.00 B12. Allocated Municipal Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B12. __________________________.00 R Property Tax from contiguous property if housesite has less than 2 acres (see instructions.) O B13. Contiguous property Education Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B13. __________________________.00 B14. Contiguous property Municipal Tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B14. __________________________.00 MAXIMUM CREDIT 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 (MMDDYYYY) Daytime Telephone Number Signature (If a joint return, BOTH must sign.) Date (MMDDYYYY) Daytime Telephone Number Paid Preparer’s Signature Date (MMDDYYYY) Preparer’s Telephone Number Firm’s Name (or yours if self-employed) and address Preparer’s SSN or PTIN FEIN 5454 Check if the Department of Taxes may discuss this return with the preparer shown. Clear ALL fields Page 2 of 2 Save and go to Important Printing Instructions Form HS-122 Rev. 10/20 Save and Print Vermont Department of Taxes *201442100* 2020 Schedule HI-144 Household Income For the year Jan 1 - Dec 31, 2020 Please PRINT in BLUE or BLACK INK * 2 0 1 4 4 2 1 0 0 * This schedule must be included with the 2020 Renter Rebate Claim (Form PR-141) OR the 2021 Property Tax Credit Claim (Form HS-122). Please read instructions before completing schedule. Claimant’s Last Name First Name MI Claimant’s Social Security Number Spouse’s/CU Partner’s Last Name First Name MI Claimant’s Date of Birth (MMDDYYYY) 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 2020. 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 /Claimant and jointly filed Spouse 2. Filing separately Spouse or CU Partner 3. Other Persons a. Cash public assistance and relief (See instructions for exclusions) . . . . a._____________.00 _____________.00 ____________ .00 b. Social Security, SSI, disability, railroad retirement, veteran’s benefits, taxable and nontaxable . . . . . . . . . . . . . . . . . . . . . . . b._____________.00 _____________.00 ____________ .00 c. Unemployment compensation/worker’s compensation. . . . . . . . . . . . . . c._____________.00 _____________.00 ____________ .00 d. Wages, salaries, tips, etc. (See instructions for dependent’s exempt income.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d._____________.00 _____________.00 ____________ .00 e. Interest and dividends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e._____________.00 _____________.00 ____________ .00 f. Interest on U.S., state, and municipal obligations, taxable and nontaxable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .f._____________.00 _____________.00 ____________ .00 g. Alimony and support money. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g._____________.00 _____________.00 ____________ .00 Please specify__________________________ . . . . . . . . . . . . . . . . . . . h._____________.00 _____________.00 ____________ .00 i. Business income. If the amount is a loss, enter -0-. See instructions for offsetting a loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i._____________.00 _____________.00 ____________ .00 j. Capital gains, taxable and nontaxable. If the amount is a loss, enter -0-. See instructions for offsetting a loss . . . . . . . . . . . . . . . . . . . j._____________.00 _____________.00 ____________ .00 k. Taxable pensions, annuities, IRA and other retirement fund and distributions. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k._____________.00 _____________.00 ____________ .00 l. Rental and royalty income. If the amount is a loss, enter -0-. See instructions for offsetting a loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . l._____________.00 _____________.00 ____________ .00 m. Farm/partnerships/S corporations/LLC/Estate or Trust income. If the amount is a loss, enter -0-. See Line m instructions for only exception to offset a loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .m._____________.00 _____________.00 ____________ .00 Please specify__________________________ . . . . . . . . . . . . . . . . . . . n._____________.00 _____________.00 ____________ .00 o. Total Income: Add Lines a through n . . . . . . . . . . . . . . . . . . . . . . . . .   o.______________ .00 ______________ ______________ .00 h. Child support and cash gifts n. Other income (see instructions for examples of other income) 5454 Page 1 of 2 .00 Schedule HI-144 Rev. 10/20 Claimant’s Last Name Social Security Number *201442200* * 2 0 1 4 4 2 2 0 0 * Carried forward from Line o. . . . . . . _____________ .00 1. Claimant /Claimant and jointly filed Spouse Medicare tax withheld on wages claimed on p. See instructions. Enter Social Security and 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.____________ .00 q. Child support paid. You must include proof of payment. See instructions . . . . . . . . q._____________ Support paid to: Last Name .00 ______________ .00 ______________ .00 2. Filing separately Spouse or CU Partner 3. Other Persons _____________ .00 _____________.00 ______________ First Name .00 MI ______________ .00 Social Security Number r. Allowable adjustments from Federal Form 1040 r1. Business expenses for Reservists . . . . r1. ____________ .00 _____________ .00 _____________.00 r2. Alimony paid . . . . . . . . . . . . . . . . . . . r2. ____________ .00 _____________ .00 _____________.00 r3. Self-employed health insurance deduction. . . . . . . . . . . . . . . r3. ____________ .00 _____________ .00 _____________.00 r4. Health Savings Account deduction. . . r4. ____________ .00 _____________ .00 _____________.00 r5. Tuition and Fees as reported on federal Form 8917. . . . . . . . . . . . . . . . r5. ____________ .00 _____________ .00 _____________.00 s. Add Lines p, q, and total of Lines r1 to r5 for each column. . . . . . . . . . . . . . . . . . . . . . . s. ____________ .00 _____________ .00 _____________.00 t. Subtract Line s from Line o of each column. If a negative amount, enter -0- .. . . . . . . . . . . t. ____________ .00 _____________ .00 _____________.00 u. Add all three amounts from Line t. If a negative amount, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u.____________ v. Complete if born Jan. 1, 1956 and after. Enter interest and dividend income from Lines e and f.. . . . . . . . . . . . . . . . . . . . . . . . . v. ____________ .00 _____________ .00 .00 _____________.00 w. Add all three amounts from Line v. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w.____________ .00 10,000.00 x. Asset Adjustment of Interest and Dividend Income (Lines e and f). Per 32 V.S.A. § 6061E. . . . . . . . . . . . . . . . . . . . . . . . . x. ________________ y. Subtract Line x from Line w. If Line x is more than Line w, enter -0- .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y.____________ .00 z. HOUSEHOLD INCOME. Add Line u and Line y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . z.____________ .00 RENTERS If Line z 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, 2021, but can be filed up to Oct. 15, 2021. 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 Credit Claim, must be filed each year. Homeowners with Household Income up to $138,500 on Line z should complete Form HS-122, Section B. You may be eligible for a property tax credit. This schedule must be filed with Form HS-122. Form HS-122 The due date to file is April 15, 2021. Homeowners filing a property tax credit, Form HS-122 and Schedule HI-144, between April 16 and Oct. 15, 2021, may still qualify for a Property Tax Credit. A $15 late filing fee will be deducted from the credit. 5454 Page 2 of 2 Schedule HI-144 Rev. 10/20
Extracted from PDF file 2020-vermont-form-hs-122-hi-144.pdf, last modified November 2020

More about the Vermont Form HS-122, HI-144 Other Tax Credit TY 2020

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. 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 February 2021, so this is the latest version of Form HS-122, HI-144, fully updated for tax year 2020. 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 February 2021.

Show Sources >

Form HS-122, HI-144 is a Vermont Other form. States often have dozens of even hundreds of various tax credits, which, unlike deductions, provide a dollar-for-dollar reduction of tax liability. Some common tax credits apply to many taxpayers, while others only apply to extremely specific situations. In most cases, you will have to provide evidence to show that you are eligible for the tax credit, and calculate the amount of the credit to which you are entitled.

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

We have a total of six 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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