Form Hi-144 - Vt Household Income - 2000 (Page 2 of 2) in pdf

Form Hi-144 - Vt Household Income - 2000 Page 2

1. Claimant

2. Spouse

3. All Others

Carried forward from Line n on front page

1. Claimant

2. Spouse

3. All Others

o. Social security and Medicare tax withheld on wages included above and/or self-employment tax paid, less any amount deducted from Federal Form

1040, Line 27. Attach W-2 forms and/or Schedule SE

___________________________________________________________________________________________________

p. Child support paid. You must attach proof of payment. See instructions.

Support paid to _______________________________________________________________________SSN

q. Adjustments to income from Federal Form 1040 Line

or 1040A Line

______________________________________________________________________________

r. TOTAL ADJUSTMENTS Add lines o, p, and q.

___________________________________________________________________________________________________________

s. ADJUSTED INCOMES OF HOUSEHOLD MEMBERS Subtract line r from line n.

___________________________________________________________________________

t. TOTAL HOUSEHOLD INCOME Add the totals of Columns 1, 2, and 3 Line s.

_____________________________________________________________________________

TOTAL

RENTERS:

If total Household Income is $47,000 or less, enter Line t on Form PR-141, Line 4.

If more than $47,000, you do not qualify for a renter rebate.

HOMEOWNERS:

Enter Line t as Household Income in the Department calculate box; OR

on Form HS-133 or HS-134 at Line 2;

on Form HS-135 at Line 5.

Form HI-144

Form Hi-144 - Vt Household Income - 2000 Page 2