Vermont Form Hi-144 - Household Income - 2007
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1
2*071441199*
FORM
2007
Household Income
HI-144
VERMONT
For the year Jan. 1– Dec. 31, 2007
* 0 7 1 4 4 1 1 9 9 *
PRINT in BLUE or BLACK INK
This form must be attached to Renter Rebate Claim (Form PR-141) OR
Property Tax Adjustment Claim (Form HS-122, Section B)
Claimant’s Social Security Number
Read instructions before completing form.
-
-
Claimant’s Last Name
First Name
Initial
Spouse or CU Partner Social Security Number
Spouse or CU Partner Last Name
First Name
Initial
-
-
List the names and Social Security Numbers of all other persons (other than a Spouse or CU Partner) who had income and lived with you during 2007. Include their income in Column 3.
Use a separate sheet of paper if needed.
1. ___________________________________________________________
2. ________________________________________________________
1. Claimant
2. Spouse/CU Partner
3. Other Persons
a. Cash public assistance/welfare
______________________________________________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
a.
a.
a.
b. Social security/railroad retirement/veteran’s benefits, taxable and nontaxable
____________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
b.
b.
b.
c. Unemployment compensation/worker’s compensation
_______________________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
c.
c.
c.
d. Wages, salaries, tips, etc. (See instructions for dependent’s exempt income.)
_________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
d.
d.
d.
e. Interest and dividends
________________________________________________________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
e.
e.
e.
f. Interest on U.S., state, and municipal obligations, taxable and nontaxable
__________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
f.
f.
f.
g. Alimony, support money, child support, cash gifts
____________________________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
g.
g.
g.
h. Business income: If the amount is a loss, enter zero. See instructions for offsetting a loss.
____________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
h.
h.
h.
i. Capital gains, taxable and nontaxable. If the amount is a loss, enter zero. See instructions for offsetting a loss.
_____________________________
.
.
.
,
,
,
0 0
0 0
0 0
i.
i.
i.
j. Pensions, annuities, retirement fund distributions. See instructions.
________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
j.
j.
j.
k. Rental income: If the amount is a loss, enter zero. See instructions for offsetting a loss.
_______________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
k.
k.
k.
l. Farm/partnerships/S Corporations/LLCs Income: If the amount is a loss, enter zero. See instructions for offsetting a loss.
___________________
.
.
.
,
,
,
0 0
0 0
0 0
l.
l.
l.
m. Other income (See instructions for examples of other income). Please specify _________________________________________________
__________
.
.
.
,
,
,
0 0
0 0
0 0
m.
m.
m.
n. TOTAL INCOME: Add Lines a through m
__________________________________________________________________________________________________________
.
.
.
,
,
,
0 0
0 0
0 0
n.
n.
n.
continued on back
35
Form HI-144
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