Form Hi-144 - Vt Household Income - 2001

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*011441100*
Household Income
* 0 1 1 4 4 1 1 0 0 *
PRINT in BLUE or BLACK INK
This form must be attached to Renter Rebate Claim OR Act 60 Property Tax Adjustment or 2002 Act 60 School Property Tax
Adjustment Application.
Read instructions before completing form.
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TOTAL INCOME
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continued on back
33

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