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Vermont Free Printable  for 2021 Vermont Renter Rebate Claim

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Renter Rebate Claim
Form PR-141, HI-144

Vermont Department of Taxes *201411100* 2020 Form PR-141 Vermont Renter Rebate Claim * 2 0 1 4 1 1 1 0 0 * For the year Jan 1 - Dec 31, 2020 Claimant’s Last Name First Name Spouse’s/CU Partner’s Last Name First Name IMPORTANT: This form MUST be filed with Schedule HI-144 and Form LC-142 or your claim will be considered incomplete. MI Claimant’s Social Security Number MI Spouse’s or CU Partner’s Social Security Number Mailing Address (Number and Street/Road or PO Box) City Claimant’s Date of Birth (MM/DD/YYYY) State Vermont School District Code / ZIP Code 911/Physical Street Address on 12/31/2020 Federal Single Filing Status Married/CU Filing Jointly / City/Town of Legal Residence on 12/31/2020 Married/CU Filing Separately Will you be using Renter Rebate to pay Income Tax liability? Head of Household & State Yes No ELIGIBILITY QUESTIONS: ALL questions must be answered. You must have rented all 12 months in 2020. See instructions for exception. 1. Were you domiciled in Vermont all of calendar year 2020? . . . . . . . . . 2. Were you claimed as a dependent by another taxpayer in 2020? . . . . . 3. Did you rent in Vermont all 12 months in calendar year 2020?. . . . . . . Yes, Go to Line 2. No, STOP. You are not eligible. Yes, STOP. You are not eligible. No, Go to Line 3. Yes, Complete this form. No, STOP. You are not eligible. REBATE CALCULATION: Before doing rebate calculation, complete Household Income (Schedule HI-144). You MUST Include Schedule HI-144 and Form LC-142 with this form. 4. E-file Certificate Number (from Form LC-142). . . . . . . . . . . . . . . . . . . . . . . . . . 4. ________________________________________________________ 5. Allocable Rent (from Form LC-142, Line 9). . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. _______________ .00 6. Home Use. If more than 25% of this rental is used for business, see instructions. If no business use, enter 100.00%. . . . . . . . . . . . . . . . . . . . . . . 6. _________._______% 7. Allowable Rent for Rebate Claim (Multiply Line 5 by Line 6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. ________________ .00 8. Household Income (from Schedule HI-144, Line z). If more than $47,000 you are not eligible.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. _______________ .00 Check here if amended Schedule HI-144, Household Income, is included. 9. Maximum Percentage of Income for Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. ______._____% If Line 8 Household Income is: $0 – 9,999 $10,000 – 24,999 $25,000 – 47,000 Enter this % on Line 9: 2.0% 4.5% 5.0% 10. Maximum Rent for Household Income (Multiply Line 8 by Line 9 and enter result here. If Line 10 is more than Line 7, you do not qualify for a renter rebate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. ________________ .00 11. Renter Rebate Amount (Subtract Line 10 from Line 7 and enter result here.) If result is zero, you do not qualify for a rebate.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. __________________.00 MAXIMUM REBATE AMOUNT IS $3,000. 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 1 of 1 Save and go to Important Printing Instructions Form PR-141 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 ______________ .00 MI Social Security Number 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 r. Allowable adjustments from Federal Form 1040 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-pr-141-hi-144.pdf, last modified October 2020

More about the Vermont Form PR-141, HI-144 Other TY 2020

This form MUST be filed with Schedule HI-144 and Form LC-142 or your claim will be considered incomplete. Form PR-141, HI-144 requires you to list multiple forms of income, such as wages, interest, or alimony .

We last updated the Renter Rebate Claim in February 2021, so this is the latest version of Form PR-141, HI-144, fully updated for tax year 2020. You can download or print current or past-year PDFs of Form PR-141, HI-144 directly from TaxFormFinder. You can print other Vermont tax forms here.


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Other Vermont Other Forms:

TaxFormFinder has an additional 51 Vermont income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form PR-141, HI-144 Renter Rebate Claim
Form LC-142 Landlord Certificate (Form LC-142)
Form HS-122, HI-144 Homestead Declaration AND Property Tax Adjustment Claim
Form 8821-VT Authorization To Release Tax Information
Form EST-195 Application for Extension of Time to File Vermont Estate Tax Return

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 PR-141, HI-144 from the Department of Taxes in February 2021.

Show Sources >

Historical Past-Year Versions of Vermont Form PR-141, HI-144

We have a total of seven past-year versions of Form PR-141, 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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