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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%
MAXIMUM REBATE AMOUNT IS $3,000.
Form PR-141
Rev. 10/20
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.
Page 1 of 1
Vermont Department of Taxes
2020 Form PR-141
Vermont Renter Rebate Claim
For the year Jan 1 - Dec 31, 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.
Check if the Department of Taxes may discuss this return with the preparer shown.
Check here if amended Schedule
HI-144, Household Income, is included.
IMPORTANT: This form MUST be filed with Schedule HI-144 and Form LC-142
or your claim will be considered incomplete.
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
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 (MM/DD/YYYY)
City State ZIP Code
Vermont School District Code 911/Physical Street Address on 12/31/2020 City/Town of Legal Residence on 12/31/2020 & State
Will you be using Renter Rebate
to pay Income Tax liability?
Head of
Household
Married/CU
Filing Separately
Married/CU
Filing Jointly
Single
Federal
Filing Status
Yes
No
/ /
-
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.
*201411100*
*201411100*
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? ......
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
9. Maximum Percentage of Income for Rent .................................. 9. _____._____%
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
5454
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