Fillable Form Lc-142 - Vt Landlord'S Certificate (Page 2 of 2) in pdf

Instructions for Form LC-142 Landlord’s Certificate

ISSUE CERTIFICATES TO TENANTS

Line 6 Check the items included in rent. “Other services” include

rubbish removal, snow removal, etc. It does not include services

By January 31st . . . . . . . . . . If you have 2 or more residential units.

necessary for occupancy such as water or sewer costs. NOTE: If

Upon tenant request . . . . . . . . . . . . . . .If you have 1 residential unit

you check items included in rent, be sure to enter the dollar value on

Line 11.

IF TENANT MOVES BEFORE END OF YEAR

Line 7 Print the name(s) of the tenants. If two or more individuals

You can provide a completed certificate to the tenant when he or she

share the same unit for the same period of time, print the name of

leaves or mail the certificate to the new address or last known address

each tenant separated by a comma. Only one certificate per rental

by the time shown above for issuing certificates to tenants. Please

unit can be issued even if there is more than one tenant in the unit.

use certificate with 10/12 revision date.

Line 8a Enter the calendar year the certificate covers.

FAILURE TO ISSUE A CERTIFICATE

Line 8b Enter the number of months the tenant rented the unit from

You may be assessed a $200 per certificate penalty for failing to

you in the calendar year in Line 8a. Only the rent paid during the

provide a tenant a certificate or failing to provide accurate information

calendar year is eligible for a renter rebate.

on the certificate.

Line 9 Enter the full monthly rent for the rental unit. If the rent

NON-PROFIT MOBILE HOME PARKS OWNED BY COOPERATIVE

changed during the year, average the monthly rental amount. For

OR TENANT/OWNERS

subsidized rent, this is the full rent charge prior to the subsidy.

Line 10 Enter the total rent amount paid in this calendar year by the

Do not issue a landlord certificate for lot rent. The non-profit park

tenant for this calendar year. Do not include delinquent rent paid

provides a letter to the tenant allocating the property tax assessed on

for prior year(s). Deposits are not part of rent paid. Do not include

the lot.

room charges for any month when paid by Medicare on behalf of the

OTHER MOBILE HOME LOT RENT

tenant.

Issue a landlord certificate for the lot rent.

Line 11 If Line 6 indicates items included in rent, enter the dollar

value of those items. If the items are not recorded by rental unit, use

RENT ELIGIBLE FOR REBATE

a reasonable allocation method such as number of rooms or square

The rent eligible for rebate is only the rent actually paid for the right

footage of the unit compared to the total number of rooms or square

of occupancy. The part of rent attributable to items included in rent

footage of the rental units in the building.

on Line 6 must be deducted to arrive at the rent paid for occupancy.

Line 13 Enter 100.00% if rent is not subsided.

NURSING HOMES, COMMUNITY CARE AND LIKE FACILITIES

For state or federal rent subsidy, enter the percentage the tenant pays.

If the subsidy pays 80% of the rent, enter 20.00 on this line. If the

Payments by Medicaid on behalf of the tenant cannot be included as

subsidy changed during the year, average the subsidy percentage.

part of rent eligible for rebate.

Signature The landlord or authorized representative signs the

A person who resides in a nursing or residential care home who owns

completed certificate. Give or mail the original certificate to the

a homestead with a sibling or spouse can claim a renter rebate if the

tenant. Keep a copy for your records.

sibling or spouse does not make a property adjustment claim.

ASSISTANCE TO COMPLETE CERTIFICATE

LINE-BY-LINE INSTRUCTIONS

Phone: 1-866-828-2865 (toll-free in VT)

CLAIMANT INFORMATION

802-828-2865 (local or out-of-state)

Fax:

802-828-2720

The Social Security Number of the Claimant is entered by the

Claimant after the certificate is completed.

INFORMATION FOR TENANTS

LANDLORD and RENTAL UNIT INFORMATION

Line 1 Enter the name of the owner of the rental property. If multiple

If you are unable to get a certificate from your landlord, call the

owners, print each owner name separated by a comma. Attach a

phone number above for assistance and more information on filing a

separate sheet of paper if you need more room. Print the mailing

renter rebate claim.

address where you wish any correspondence concerning this rental

You may claim a renter rebate even if you are not required to file an

unit to be sent.

income tax return.

Line 2 Enter the physical location of the rental unit.

Example: 123 Main Street Apt 3

Line 3 Enter the School Parcel Account Number (SPAN) for this

rental property. The SPAN is found on the property tax bill.

Line 4 Enter the number of rental units in this property. For mobile

home parks, enter the number of lots.

Line 5 Check the applicable box that best describes the rental unit

type.

Form LC-142

Rev. 10/12

Form Lc-142 - Vt Landlord'S Certificate Page 2

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