Form Hs-122 - Vermont Homestead Declaration And Property Tax Adjustment Claim - 2013
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2*131221199*
Homestead Declaration
2013
FORM
AND Property Tax
HS-122
VERMONT
Adjustment Claim
* 1 3 1 2 2 1 1 9 9 *
DUE DATE: April 15, 2013 (Claims allowed up to October 15, 2013 but late filing penalties apply)
Please PRINT in BLUE or BLACK INK
This form can be filed on-line at
To file a Homestead Declaration:
Please complete Section A, sign the back and send to the Department .
To file a Property Tax Adjustment Claim:
Please complete Section A and Section B, sign and send to the Department together with a completed HI-144 Household
Income Schedule . You will not receive a Property Tax Adjustment unless you file a Homestead Declaration, a Property
Tax Adjustment Claim, and a Household Income schedule no later than October 15, 2013 .
ANNUAL Vermont Homestead Declaration
SECTION A.
This form must be filed EACH YEAR by ALL VT residents who own and occupy
a VT homestead on April 1 even if a claim for property tax adjustment is not made.
Month
Day
Year
-
-
-
-
Claimant Social
Spouse or CU Partner
Claimant ’s
Security Number
Social Security Number
Date of Birth
Claimant ’s
First
First
Initial
Last Name
Name
Name
Spouse or
First
First
CU Partner
Initial
Name
Name
Last Name
Mailing Address
(Number and Street/
Road or PO Box)
-
Zip
City/Town
State
Code
Location of
A1. VT School
Homestead
District Code
A2. City/Town of Legal Residence on 04/01/2013
State
number, street / road name (Do not use PO Box, “same”, or Town name)
-
-
A3. SPAN Number
(From your 2012/2013 property tax bill)
(REQUIRED)
0 0 %
.
A4. Business Use of Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A4.
0 0 %
.
A5. Rental Use of Dwelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A5.
A6. Business or Rental Use of Improvements or Other Buildings
Not including the dwelling, are improvements or other buildings located on your parcel
c
c
used for business or rented? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
A7 - A10 Special Situations (see instructions for more information) . Check the following if it applies:
c
A7. Grantor and sole beneficiary of a revocable trust owning the property .
c
A8. Life estate holder of the property .
c
A9. Homestead property crosses town boundaries . (File a declaration for each town .)
c
A10. Residing in a dwelling owned by a related farmer .
IMPORTANT FILING INFORMATION
•
If you will not be filing a Property Tax Adjustment Claim, please sign the back of this return .
•
If you will be filing a Property Tax Adjustment Claim, continue on to complete Section B .
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Form HS-122
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