Form Hs-139 - Homeowner Property Tax Rebate Claim - Vermont Department Of Taxes - 2003
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2*031391199*
Homeowner Property Tax Rebate
Claim
* 0 3 1 3 9 1 1 9 9 *
FOR HOUSEHOLD INCOME OF $47,000 OR LESS
PRINT in BLUE or BLACK INK
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N N E E W W
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Q1. Were you claimed as a dependent in 2003 by another taxpayer?
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c
c
NO
YES, STOP You are not eligible.
Q2. Were you domiciled (legal resident) in VT all of calendar year 2003?
c
c
YES
NO, STOP You are not eligible.
Q3. Did you own and occupy your VT homestead on December 31, 2003?
c
c
YES
NO, STOP You are not eligible.
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continued on back
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