Form PR-141 "Vermont Renter Rebate Claim" - Vermont

What Is Form PR-141?

This is a legal form that was released by the Vermont Department of Taxes - a government authority operating within Vermont. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Vermont Department of Taxes;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PR-141 by clicking the link below or browse more documents and templates provided by the Vermont Department of Taxes.

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Download Form PR-141 "Vermont Renter Rebate Claim" - Vermont

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Vermont Renter
For the year
*1814111WW*
Jan 1 - Dec 31, 2018
Rebate Claim
Must Be Filed With: Household
2018 Form PR-141
Income (Schedule HI-144) and
* 1 8 1 4 1 1 1 W W *
Landlord Certificate (Form LC-142)
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 (Number and Street/Road or PO Box)
Claimant’s Date of Birth (MM DD YYYY)
City
State
ZIP Code
Federal Filing Status (Single=S;
Head of Household=H; Joint=J; Separate=P)
Physical Location of Rental Property (Use a number, street/road name. Do not use a PO Box or “Same”) E-file Certificate Number (From LC-142), if available
1. Vermont School District Code
2. City/Town of Legal Residence on Dec. 31 2018
State
Will you be using Renter Rebate to pay Income
Yes
No
Tax liability?
ALL Eligibility questions must be answered. You must have rented all 12 months in 2018. See instructions for exception.
Yes, Go to Q2
No, STOP. You are not eligible.
Q1. Were you domiciled in Vermont all of calendar year 2018? . . . . . . . . . . . .
Yes, STOP. You are not eligible
No, Go to Q3
Q2. Were you claimed as a dependent by another taxpayer in 2018? . . . . . . .
Q3. Did you rent in Vermont all 12 months in calendar year 2018? . . . . . . . . . .
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.
3.
Allocable Rent (from Form LC-142) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.00
3
4.
Home Use. If more than 25% of this rental is used for business, see instructions.
%
If no business use, enter 100.00% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5.
Allowable Rent for Rebate Claim (Multiply Line 3 by Line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.00
6.
Household Income (Schedule HI-144, Line Y) If more than $47,000 you are not eligible . .
6
.00
6a. If Amended Schedule HI-144, Household Income, is included, check here:
%
7.
Maximum Percentage of Income for Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
If Line 6 Household Income is:
$0 – 9,999
$10,000 – 24,999
$25,000 – 47,000
Enter this % on Line 7:
2.0%
4.5%
5.0%
8.
Maximum Rent for Household Income (Multiply Line 6 by Line 7 and enter result here.
If Line 8 is more than Line 5, you do not qualify for a renter rebate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.00
8
Renter Rebate Amount (Subtract Line 8 from Line 5 and enter result here.) If result is zero, you do not qualify for a rebate.
9.
If using your rebate to pay your Vermont Income Tax liability, also enter this amount on Schedule IN-112, Part II, Line 2 . . . . . . . .
.00
9
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
Telephone Number
Signature
Date
Telephone Number
(If a joint return, BOTH must sign.)
Preparer’s Signature
Date
Preparer’s SSN or PTIN
Telephone Number
Firm’s Name (or your name if self-employed) and address
EIN
May the Department of Taxes contact your preparer? YES
Form PR-141
Rev. 10/18
Page 1 of 1
Clear ALL fields
Save and go to Important Printing Instructions
Save and Print
Vermont Renter
For the year
*1814111WW*
Jan 1 - Dec 31, 2018
Rebate Claim
Must Be Filed With: Household
2018 Form PR-141
Income (Schedule HI-144) and
* 1 8 1 4 1 1 1 W W *
Landlord Certificate (Form LC-142)
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 (Number and Street/Road or PO Box)
Claimant’s Date of Birth (MM DD YYYY)
City
State
ZIP Code
Federal Filing Status (Single=S;
Head of Household=H; Joint=J; Separate=P)
Physical Location of Rental Property (Use a number, street/road name. Do not use a PO Box or “Same”) E-file Certificate Number (From LC-142), if available
1. Vermont School District Code
2. City/Town of Legal Residence on Dec. 31 2018
State
Will you be using Renter Rebate to pay Income
Yes
No
Tax liability?
ALL Eligibility questions must be answered. You must have rented all 12 months in 2018. See instructions for exception.
Yes, Go to Q2
No, STOP. You are not eligible.
Q1. Were you domiciled in Vermont all of calendar year 2018? . . . . . . . . . . . .
Yes, STOP. You are not eligible
No, Go to Q3
Q2. Were you claimed as a dependent by another taxpayer in 2018? . . . . . . .
Q3. Did you rent in Vermont all 12 months in calendar year 2018? . . . . . . . . . .
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.
3.
Allocable Rent (from Form LC-142) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.00
3
4.
Home Use. If more than 25% of this rental is used for business, see instructions.
%
If no business use, enter 100.00% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5.
Allowable Rent for Rebate Claim (Multiply Line 3 by Line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.00
6.
Household Income (Schedule HI-144, Line Y) If more than $47,000 you are not eligible . .
6
.00
6a. If Amended Schedule HI-144, Household Income, is included, check here:
%
7.
Maximum Percentage of Income for Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
If Line 6 Household Income is:
$0 – 9,999
$10,000 – 24,999
$25,000 – 47,000
Enter this % on Line 7:
2.0%
4.5%
5.0%
8.
Maximum Rent for Household Income (Multiply Line 6 by Line 7 and enter result here.
If Line 8 is more than Line 5, you do not qualify for a renter rebate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.00
8
Renter Rebate Amount (Subtract Line 8 from Line 5 and enter result here.) If result is zero, you do not qualify for a rebate.
9.
If using your rebate to pay your Vermont Income Tax liability, also enter this amount on Schedule IN-112, Part II, Line 2 . . . . . . . .
.00
9
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
Telephone Number
Signature
Date
Telephone Number
(If a joint return, BOTH must sign.)
Preparer’s Signature
Date
Preparer’s SSN or PTIN
Telephone Number
Firm’s Name (or your name if self-employed) and address
EIN
May the Department of Taxes contact your preparer? YES
Form PR-141
Rev. 10/18
Page 1 of 1
Clear ALL fields
Save and go to Important Printing Instructions
Save and Print
Vermont Household Income
Please PRINT in BLUE or BLACK INK
2018 Schedule HI-144
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
2. Filing separately Spouse or
1. Claimant and jointly filed
Yearly totals of ALL
3. Other Persons
CU Partner
Spouse
members of the household
a. Cash public assistance and relief . . . . . . . . . . . . . . . .
a
.00
a
.00
a
.00
b. Social Security, SSI, disability, railroad retirement,
veteran’s benefits, taxable and nontaxable . . . . . . . . .
b
.00
b
.00
b
.00
c. Unemployment compensation/worker’s compensation
c
.00
c
.00
c
.00
d. Wages, Salaries, tips, etc. (See instructions for
dependent’s exempt income.) . . . . . . . . . . . . . . . . . . .
d
.00
d
.00
d
.00
e. Interest and dividends . . . . . . . . . . . . . . . . . . . . . . . . .
e
e
.00
.00
e
.00
f. Interest on U.S., state, and municipal obligations,
taxable and nontaxable . . . . . . . . . . . . . . . . . . . . . . . .
f
.00
f
.00
f
.00
g. Alimony, support money, child support, cash gifts . . . .
g
.00
g
.00
g
.00
h. Business income. If the amount is a loss, enter -0-,
See instructions for offsetting a loss . . . . . . . . . . . . . .
h
.00
h
.00
h
.00
i. Capital gains, taxable and nontaxable. If the amount is
a loss, enter -0-, See instructions for offsetting a loss
i
.00
i
.00
i
.00
j. Taxable pensions, annuities, IRA and other retirement
fund and distributions. See Instructions . . . . . . . . . . .
j
.00
j
.00
j
.00
k. Rental and royalty income. If the amount is a loss,
enter -0-. See instructions for offsetting a loss. . . . . . .
k
.00
k
.00
k
.00
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 . . . . . . .
l
.00
l
.00
l
.00
m. Other income (see instructions
for examples of other income) . . . . . . . . . . . . . . . . . . .
m
.00
m
.00
m
.00
Please Specify______________________________
n. Total Income: Add Lines a through m . . . . . . . . . . . . .
n
.00
n
.00
n
.00
*1814411WW*
* 1 8 1 4 4 1 1 W W *
Schedule HI-144
Page 1 of 2
Rev. 10/18
Taxpayer’s Last Name
Social Security Number
2. Filing separately Spouse or
1. Claimant and jointly filed
3. Other Persons
CU Partner
Spouse
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
o
o
o
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 . . . . . . . . . . . . . . . . . . . . . . . . . .
.00
.00
.00
p. Child support paid. You must include proof of payment.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
p
p
p
.00
.00
.00
Support paid to: Last Name
First Name
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
q2
q2
.00
.00
.00
q3. Tuition and fees . . . . . . . . . . . . . . . . . . . . . . . . . .
q3
q3
q3
.00
.00
.00
q4. Self-employed health insurance deduction . . . . . .
q4
q4
q4
.00
.00
.00
q5. Health Savings Account deduction . . . . . . . . . . . .
q5
q5
q5
.00
.00
.00
r. Add Lines o, p, and total of Lines q1 to q5 for
each column. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r
r
r
.00
.00
.00
s. Subtract Line r from Line n of each column.
If a negative amount, enter -0- . . . . . . . . . . . . . . . . . . .
s
s
s
.00
.00
.00
t. Add all three amounts from Line s. If a negative amount, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
t
.00
u. Complete if born Jan 1, 1954 and after.
Enter interest and dividend income from Lines e and f.
u
u
u
.00
.00
.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
HOUSEHOLD INCOME.
y.
Add Line t and Line x . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
y
.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*
Schedule HI-144
* 1 8 1 4 4 1 2 W W *
Page 2 of 2
Rev. 10/18
Page of 3