Form Hi-144 - Vt Household Income - 2000
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2VT. DEPT. OF TAXES, Montpelier, Vermont 05609-1401 / (802) 828-2865
2000 VT
Household Income
For the year Jan. 1–Dec. 31,
2000
DUE DATE: April
17, 2001
• PRINT in BLUE or BLACK INK
This form must be attached to Renter Rebate Claim OR Act 60 Property Tax Calculation form. Read instructions before completing form.
Taxpayer’s Social Security Number
Taxpayer’s Last Name
First Name
Initial
Spouse’s Social Security Number
Spouse’s Last Name
First Name
Initial
List the names and social security numbers of all other persons who had income and lived with you during 2000. Include their income in column 3. Use a separate sheet of paper if needed.
1. ________________________________________________________________________
2. ______________________________________________________________________
1. Claimant
2. Spouse
3. All Others
a. Cash public assistance/welfare
_________________________________________________________________________________________________________________________
a.
a.
a.
b. Social security/railroad retirement/veteran’s benefits, taxable and nontaxable
_______________________________________________________________________
b.
b.
b.
c. Unemployment compensation/worker’s compensation
__________________________________________________________________________________________________
c.
c.
c.
d. Wages, salaries, tips, etc. (See instructions for reportable dependent’s income.)
________________________________________________________________________
d.
d.
d.
e. Interest and dividends
__________________________________________________________________________________________________________________________________
e.
e.
e.
f. Interest on U.S., state, and municipal obligations, taxable and nontaxable
_____________________________________________________________________________
f.
f.
f.
g. Alimony, support money, child support
__________________________________________________________________________________________________________________
g.
g.
g.
h. Business income: See instructions if you have a loss.
_________________________________________________________________________________________________
h.
h.
h.
i. Capital gains, taxable and nontaxable. See instructions if you have a loss.
__________________________________________________________________________
i.
i.
i.
j. Pensions, annuities, retirement fund distributions, taxable and nontaxable
____________________________________________________________________________
j.
j.
j.
k. Rental income: See instructions if you have a loss.
___________________________________________________________________________________________________
k.
k.
k.
l. Farm/partnerships/S Corporations/LLCs Income: See instructions if you have a loss.
________________________________________________________________
l.
l.
l.
m. Other income. Please specify ______________________________________________________
_____________________________________________________
m.
m.
m.
n. TOTAL INCOME: Add Lines a through m
____________________________________________________________________________________________________________
n.
n.
n.
continued on back
Form HI-144
25
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