Fillable Printable Renters Rebate Sample Form
Fillable Printable Renters Rebate Sample Form
Renters Rebate Sample Form
3. ALLOCABLE RENT (LC-142, Line 16) ............................................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. ________________________
6. HOUSEHOLD INCOME (Schedule HI-144, Line y) If more than $47,000, you are not eligible. 6. _______________________
6a. If AMENDED SCHEDULE HI-144, Household Income, is attached, check here. c
7. MAXIMUM PERCENTAGE OF INCOME FOR RENT ..............................7. _______________________
8. MAXIMUM RENT FOR HOUSEHOLD INCOME (Multiply Line 6 by Line 7 and enter result here) .......................8. ________________________
If Line 8 is more than Line 5, you do not qualify for a renter rebate.
9. RENTER REBATE AMOUNT (Subtract Line 8 from Line 5 and enter result here.) If result is zero, you do not qualify
for a rebate. If filing this form with the VT Income Tax Return, also enter this amount on Form IN-111, Line 31d. ......... è 9. ________________________
MAXIMUM REBATE AMOUNT IS $3,000.
ALL eligibility questions must be answered. You must have rented all 12 months in 2013. See instructions on page 44 for exception.
Q1. Were you domiciled in VT all of calendar year 2013? ................... c Yes, Go to Q2. c No, STOP. You are not eligible.
Q2. Were you claimed as a dependent by another taxpayer in 2013? ........... c Yes, STOP. You are not eligible. c No, Go to Q3.
Q3. Did you rent in VT all 12 months in calendar year 2013? ................ c Yes, Complete this form c No, STOP. You are not eligible.
Before doing rebate calculation, complete Household Income (Schedule HI-144).
YOU MUST ATTACH SCHEDULE HI-144 AND THE LC-142 TO THIS FORM.
REBATE CALCULATION
Form PR-141
Must Be Filed With: Household Income (Schedule HI -144) and Landlord’s Certificate (LC-142)
*131411100*
*131411100*
FORM
PR-141
Renter Rebate Claim
2013
VERMONT
FOR HOUSEHOLD INCOME OF $47,000 OR LESS
For the year Jan. 1–Dec. 31, 2013
25
DUE DATE: April 15, 2014 (Claims allowed up to Oct. 15, 2014)
Please PRINT in
BLUE or BLACK INK
Keep a copy for your records.
MAIL TO: VT Department of Taxes, PO Box 1881, Montpelier, VT 05601-1881
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%
Signature Date Telephone Number
Signature. If a joint return, BOTH must sign. Date
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.
Preparer’s
Use Only
Preparer’s signature Date Preparer’s
SSN or
PTIN
Firm’s name (or yours if self-employed) and address EIN
Preparer’s Telephone Number
Check here if authorizing the VT Department of Taxes to discuss this return and attachments with your preparer.
5454
Page 25
Attach Schedule HI-144 and Form LC-142
Claimant’s Last Name First Name Initial Claimant’s Social Security Number
Spouse or CU Partner Last Name First Name Initial Spouse or CU Partner Social Security Number
Mailing Address (Number and Street/Road or PO Box) Claimant’s Date of Birth (MM DD YYYY)
City State ZIP Code
Location of rental property (number, street/road name (Do not use “PO Box”, “same”, or Town name)
1. VT School District Code 2. City/Town of Legal Residence on 12/31/2013 State
.0 0 %
.0 0
.0 0
.0 0
.0 0
.0 0
.0 0 %
/ /
The Renter Rebate Program refunds eligible renters the portion of
rent paid that exceeds an established percentage of household income.
Do NOT file a renter rebate if you rent a lot for your mobile home.
See instructions for HS-122.
TENANTS ARE TO RECEIVE THE LANDLORD’S
CERTIFICATE BY
Date If Landlord has
January 31, 2014 or before ............2 or more residential units
Upon tenant request ........................ 1 residential unit
Submit a completed Landlord’s Certificate, LC-142, for each rental
unit you occupied in calendar year 2013.
MISSING INFORMATION OR INCOMPLETE FILING:
Claims that are incomplete or are missing information are not
considered filed. The information must be provided by the
October 15 filing deadline. Information received after that time
cannot be accepted.
INJURED SPOUSE CLAIMS: To make an “injured spouse”
claim, send the following information prior to filing your claim:
(1) the request letter; and,
(2) copy of Federal Form 8379 (if you filed one with the
IRS).
Mail To: VT Department of Taxes, ATTN: Injured Spouse Unit,
PO Box 1645, Montpelier VT 05601-1645.
The Department will notify you if the renter rebate is taken to
pay a bill. You have 30 days from the date on the notice to
submit the injured spouse claim to the Department.
ELIGIBILITY FOR RENTER REBATE: You must meet ALL of
the following eligibility requirements:
• YouweredomiciledinVTfortheentirecalendaryear
2013 and,
• Youwerenotclaimedin2013asadependentofanother
taxpayer; and,
• Yourhouseholdincomein2013didnotexceed$47,000;
and,
• Youaretheonlypersoninthehouseholdmakingarenter
rebate claim; and,
• YourentedinVTforall12monthsin2013.Seepage44
for the one exception.
DECEASED RENTER: A claim cannot be filed on behalf of a
deceased person. The right to file a renter rebate claim is personal
to the claimant and does not survive the claimant’s death.
NURSING OR RESIDENTIAL CARE HOME: The Renter
Rebate Claim is for the room occupancy charge only. Services
such as heat, electricity, personal services, medical services, etc.,
must be deducted. Generally, the room charge is 25% of the
total charges to the person. For a percentage greater than 25%,
a breakout of costs must be provided. Payments by Medicaid on
behalf of the Claimant to the nursing home are not part of rent
paid.
NOTE: A person residing in a nursing or residential care home that
owns a homestead with a sibling or spouse can claim a renter
rebate if the sibling or spouse does not make a property tax
adjustment claim.
LINE-BY-LINE INSTRUCTIONS
Complete Schedule HI-144 FIRST. If Line y is more than $47,000,
you are ineligible.
Supporting Documents Required: Schedule HI-144 and LC-142
Claimant’s Date of Birth Enter your date of birth
Claimant Information Enter your name, your spouse/civil union
partner name, mailing address and Social Security number(s).
The rebate is issued to the name(s) and address on record. The
claimant is the leaseholder or the person responsible for the rent.
Only one claim per household is allowed.
Line 1 VT School District Code Go to the table on page 14 and
select the three-digit school district code for the town where you
lived on December 31, 2013.
Line 2 Legal Residence Enter your legal residence as of
December 31, 2013. Your legal residence is where you lived and
may be different from your mailing address.
Location of Rental Property Enter the physical location as of
12/31/2013. DO NOT enter a post office box, “same”, “see
above,” or the town name.
Eligibility Questions ALL questions must be answered or the claim
cannot be processed. Check the appropriate “Yes” or “No” box
for Q1, Q2 and Q3 to determine your eligibility.
Rebate Calculation
Only the rent paid during the calendar year is eligible for a renter
rebate.
Line 3 Allocable Rent Enter amount from the Landlord’s
Certificate, LC-142, Line 16. Allocable rent is based on rent
paid in a calendar year. MORE THAN ONE LANDLORD’S
CERTIFICATE: Add Line 16 from each certificate and enter
amount on this line. File all LC-142s with your claim. If
the landlord certificate has indicated on Line 6 items that are
included in rent and Line 11 on the landlord certificate is left
blank, the allowable rent will automatically be reduced by 50%
except rental in nursing homes, community care, assisted living,
and like facilities and boarding houses will be reduced by 75%.
Line 4 Home Use If you use more than 25% of your rental unit’s
floor space for business purposes, the allowable rent amount
is adjusted. The percentage of business use is generally the
same percentage used on your Federal Form 8829. To calculate
business use, divide the square feet used for business by the total
square feet in the rental unit. Example: You use an 11’ x 12’
room for an office and inventory storage. Your rental unit is
484 square feet (including the business use). Your business use
is 11 x 12 = 132 f
2
/ 484 = .27 or 27% business use. Entry on
Line 4 for home use is 73.00 (100% - 27%).
If the rental unit is used solely as your home, or business use is
25% or less, enter 100% on Line 4.
Line 5 Allowable Rent for Rebate Claim Multiply Line 3 by
Line 4.
Line 6 Household Income Enter the amount from Schedule HI-144,
Line y.
Line 7 Maximum Percentage of Income for Rent Use the chart to
find your household income range and applicable percentage.
Enter that percentage here.
Line 8 Maximum Allowable Rent for Household Income Multiply
Line 6 by Line 7. If Line 8 is more than or the same as Line 5,
you are not eligible.
Line 9 Renter Rebate Amount Subtract Line 8 from Line 5. This is
your 2013 renter rebate. If you are filing the renter rebate claim
with your 2013 VT income tax return, also enter this amount
on Form IN-111, Line 31d. You may be issued one check
combining any income refund and rebate due you.
NOTE: A Renter Rebate cannot exceed $3,000.
Signature Sign the claim.
Date Write the date on which the claim form was signed.
Disclosure Authorization If you wish to give the Department
authorization to discuss your 2013 Renter Rebate Claim with
your tax preparer, check this box and include the preparer’s
name.
Preparer If you are a paid preparer, you must also sign the claim,
enter your Social Security number or PTIN and, if employed by
a business, the EIN of the business.
If someone other than the filer(s) prepared the return without
charging a fee, then that preparer’s signature is optional.
Form PR-141
Instructions for Form PR-141 Renter Rebate Claim
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