Form Hs-145 - Vermont Property Tax Adjustment Claim

*121451100*

Property Tax

2012

FORM

HS-145

Adjustment Claim

VERMONT

* 1 2 1 4 5 1 1 0 0 *

DUE DATE: April 17, 2012 (Claims allowed up to September 4, 2012 but late filing penalties apply)

PRINT in BLUE or BLACK INK

Month

Day

Year

Claimant Social

Spouse or CU Partner

Claimant ’s

Security Number

Social Security Number

Date of Birth

Claimant ’s

First

Initial

Last Name

Name

Spouse or

First

CU Partner

Initial

Name

Last Name

Mailing Address

(Number and Street/

Road or PO Box)

Zip

City/Town

State

Code

Location of

VT School

Homestead

District Code

2. City/Town of Legal Residence on 04/01/2012

State

number, street / road name (Do not use PO Box, “same”, or Town name)

3. SPAN Number

(From your 2011/2012 property tax bill)

(REQUIRED)

ALL eligibility questions must be answered.

You must own and occupy the property as your home on April 1, 2012.

4. Were you domiciled in (legal resident of) VT all of calendar year 2011? . . . . . . . . . . . .

Yes, Go to Line 5.

No, STOP

5. Were you claimed as a dependent in 2011 by another taxpayer? . . . . . . . . . . . . . . . . . . .

Yes, STOP

No, Go to Line 6.

6. Do you anticipate selling your VT housesite on or before April 1, 2012? . . . . . . . . . . . .

Yes, STOP

No, CONTINUE

Amounts for Lines 7 - 9 are found on your 2011/2012 property tax bill.

0 0

7. Housesite Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.

0 0

8. Housesite Education Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.

0 0

9. Housesite Municipal Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.

0 0 %

10. Ownership Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.

0 0

11. Household Income (Schedule HI-144, Line y) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.

Check here if AMENDED SCHEDULE HI-144, Household Income, is attached. See instructions.

Select ONE of the applicable line sets: Line 12 OR Lines 13-14 OR Lines 15-16. See instructions on reverse side for details.

Lot Rent

0 0

12. Mobile Home Lot Rent (LC-142, Line 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.

OR Allocated Property Tax from Land Trust, Cooperative, or Nonprofit Mobile Home Park

0 0

13. Allocated Education Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.

0 0

14. Allocated Municipal Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

OR Property Tax from contiguous property if housesite has less than 2 acres

0 0

15. Education Tax on contiguous property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.

0 0

16. Municipal Tax on contiguous property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.

MAXIMUM ADJUSTMENT AMOUNT IS $8,000.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct and complete. Preparers cannot use return information for purposes other than preparing returns.

SIGN

HERE

Claimant Signature

Date

Spouse or CU Partner Signature

Date

Check here if authorizing the VT Department of Taxes to discuss this return and attachments with your preparer.

Preparer’s signature

Date