1                                                                                                                                                                                                                                                                                1
 0  0  0  0 20  0  0  0  0  1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                             2
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          3                                                                                                                                                                                                                                                                                3
          4                    Vermont Department of Taxes                                                                                                                                                                                                                                 4
          5                                                                                                                                                                                                                                                                                5
          6                          2024 Form HS-122                                                                                                                             *241221100*                                                                                              6
          7                                                                                                                                                                                                                                                                                7
                    Vermont Homestead Declaration AND                                                                                                                             * 24 1221100*
          8                    Property Tax Credit Claim                                                                                                                                                                                                                                   8  Page 29
          9                                                                                                                                                                                                                                                                                9
          10                                                                                                                                                                                                                                                                               10
          11     DUE DATE:           April 15, 2024 .  You may file up to Oct . 15, 2024, but the town may assess a penalty .  For details on late filing, see instructions .                                                                                                              11
          12                                                                                                                                                                                                                                                                               12
          13                                                                                                                                                                                                                                                                               13
                 How to file a Homestead Declaration: Please complete Section A of this form, sign in the signature section at the bottom of page 2, and send 
          14                                                                                                                                                                                                                                                                               14
                                              the form to the Vermont Department of Taxes .
          15                                                                                                                                                                                                                                                                               15 FORM  (Place at FIRST page)
          16     How to file a Property Tax Credit Claim: To be considered for a Property Tax Credit, you must file a 1) Homestead Declaration (Section A of                                                                                                                               16 Form pages 
          17                                  this form), 2) Property Tax Credit Claim (Section B of this form), and 3) Schedule HI-144, Household Income .  Sign this form                                                                                                                17
          18                                  in the signature section at the bottom of page 2 and send the forms to the Department .                                                                                                                                                      18
          19                               Tired of paper forms? It’s fast and convenient to file your claim online at myVTax.vermont.gov.                                                                                                                                                 19
          20                                                                                                                                                                                                                                                                               20
          21                                                                                                 Annual Vermont Homestead Declaration                                                                                                                                          21
                                                                                                                                                                                                                                                                                              29 - 30
          22                                                                                                                                                                                                                                                                               22
          23                                     This form must be filed each year by every Vermont resident whose property meets the definition of a homestead .                                                                                                                          23
                                                 A Vermont homestead is the principal dwelling and parcel of land surrounding the dwelling, owned and occupied by a resident 
          24           SECTION A.                                                                                                                                                                                                                                                          24
                                                 individual as the individual’s domicile on April 1, 2024 .  If your homestead is leased to a tenant on April 1, 2024, you may still 
          25                                     claim it as a homestead if it is not leased for more than 182 days in the 2024 calendar year .                                                                                                                                            25
          26                                                                                                                                                                                                                                                                               26
          27     Please PRINT in BLUE or BLACK INK                                                                                                                                                                                                                                         27
          28                         Claimant’s Last Name                                                                      First Name                                         MI                            Claimant’s Social Security Number                                          28
          29                                                                                                                                                                                                                                                                               29
                   12345678901234567      12345678901234567    1   123456789
          30                Spouse’s/CU Partner’s Last Name                                                                    First Name                                         MI                Spouse’s or CU Partner’s Social Security Number                                        30
          31                                                                                                                                                                                                                                                                               31
                   12345678901234567      12345678901234567    1   123456789
          32                                                 Mailing Address (Number and Street/Road or PO Box)                                                                                           Claimant’s Date of Birth (MM/DD/YYYY)                                            32
          33       123456789012345678901234567890123456               MM /       DD /                                                                                                                                                   YYYY                                               33
          34                                        City                                                  State                                  ZIP Code                                                                                                                                  34
          35                                                                                                                                                                                                                                                                               35
                   123456789012345678901    12   1234567890  
          36                      Location of Homestead (Use a number, street/road name.  Do not use a PO Box or “same.”)                                                                     City/Town of Legal Residence on April 1, 2024  and  State                                    36
          37                                                                                                                                                                                                                                                                               37
                   123456789012345678901234567890123456            123456789012345678   12
          38        Federal                                                                                                                                                                                                                                                                38
                                                                                                                      Filing Jointly                                                       Filing Separately                                                       Household
          39              Filing Status    X                 Single                                             X                 Married/CU                                         X                 Married/CU                                                 XHead of                 39
          40                                                                                                                                                                                                                                                                               40
          41                                                                                                                                                                                                                                                                               41
                   A1. 
          42                                                          SPAN - REQUIRED (from the 2023/2024 property tax bill)  . . . . . . . . . . . . . . . . . . . . . . . .A1.  ______________________________________123  - 456  -                             12345                    42
          43                                                                                                                                                                                                                                                                               43
                  A2.
          44                                                                        Business Use of Dwelling  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  . A2..  .  __________123.______12%  44
          45                                                                                                                                                                                                                                                                               45
                   A3. 
          46                                                                      Rental Use of Dwelling  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  . A3..  . __________123.______12%   46
          47                                                                                                                                                                                                                                                                               47
          48                Business or Rental Use of Improvements or Other Buildings                                                                                                                                                                                                      48
                  A4. 
          49                                                                       Not including the dwelling, are improvements or other buildings located on your parcel used for business or rented?  . . . A4..                                                X    Yes       X      No 49
          50                                                                                                                                                                                                                                                                               50
          51     A5-A8 Special  Situations (See instructions for more information) . Check the following if it applies:                                                                                                                                                                    51
          52                                                                                                                                                                                                                                                                               52
          53        X                                 A5. Grantor and sole beneficiary of a                                                         X     A7.   Homestead property crosses town boundaries                                                                                 53
          54                      revocable trust owning the property                                                                                           (File a declaration for each town.)                                                                                        54

          55        X                                 A6. Life estate holder of the property                                                        X     A8.   Residing in a dwelling on the homestead                                                                                    55
          56                                                                                                                                                    parcel owned by a related farmer.                                                                                          56
          57                                                                                                                                                                                                                                                                               57
          58     Please continue to Page 2, Part B, for property tax credit .  Sign on Page 2 .                                                                                                                                                                                            58
          59     Mail to:  Vermont Department of Taxes                                                                                                                                                                                                                                     59
          60                 PO Box 1881                                                                                                                                                                                                                                                   60
          61                 Montpelier, VT  05601-1881                                                                                                                                                                        2024 Form HS-122                                            61
          62                                                                                                                                                                                                                                  Page 1 of 2                                  62
          63                            5454                                                                                                                                                                                                     Rev. 10/23                                63
 0  0  0  0 640  0  0  0  0 1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                             64
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          65                                                                                                                                                                                                                                                                               65
          66                                                                                                                                                                                                                                                                               66

          1                                                                                                                                                                                                                                                                                   1
 0  0  0  0 20  0  0  0  0  1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                                2
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          3                                                                                                                                                                                                                                                                                   3
          4                                            Claimant’s Last Name                                     Social Security Number                                                                                                                                                        4
          5                                                                                                                                                                                                                                                                                   5
                         12345678901234567    123456789
          6                                                                                                                                                                       *241221200*                                                                                                 6
                 DUE DATE:
          7                          April 15, 2024. Generally, claims cannot be accepted after Oct. 15, 2024.                                                                    * 24 1221200*                                                                                               7
          8                                                                                                                                                                                                                                                                                   8  Page 30
          9                                                                                                                                                                                                                                                                                   9
          10                                                                                                 PROPERTY TAX CREDIT CLAIM                                                                                                                                                        10
                       SECTION B.
          11                                              For Household Income up to $128,000.  Complete and attach Schedule HI-144.                                                                                                                                                          11
          12     To qualify, you must meet the requirements for filing a homestead declaration in addition to the following requirements.                                                                                                                                                     12
          13     ALL eligibility questions must be answered.                                                                                                                                                                                                                                  13

          14                                             B1.  Were you domiciled in Vermont all of calendar year 2023?   . . . . . . .                     X                Yes, Go to Line B2.                          X     No, STOP.                                                      14
          15                                                                                                                                                                                                                                                                                  15 FORM  (Place at LAST page)
          16      B2.                                       Were you claimed as a dependent in 2023 by another taxpayer?  . . . .                          X                Yes, STOP.                                   X     No, Go to Line B3.                                             16 Form pages 
          17      B3.       Do you anticipate selling this Vermont housesite on or                                                                                                                                                                                                            17
          18                                            before April 1, 2024?   . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  . X                .  .Yes, STOP.                             X     No, Continue                                                   18
          19                                                                                                                                                                                                                                                                                  19
          20     Amounts for Lines B4 through B6 are found on the 2023/2024 property tax bill.  Round amounts to the nearest dollar.                                                                                                                                                          20

                   B4.                                                                                                                                                                                                                                                                           29 - 30
          21                                                                1234567890123Housesite Value   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B4..__________________________.00      21
          22                                                                                                                                                                                                                                                                                  22
                 B5. 
          23                                                                 123456789012Housesite Education Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B5..__________________________.00           23
          24                                                                                                                                                                                                                                                                                  24
                   B6. 
          25                                                                 123456789012Housesite Municipal Tax   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B6..__________________________.00            25
          26                                                                                                                                                                                                                                                                                  26
                   B7. 
          27                                                                      Ownership Interest   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  . B7..  .  __________.123.______12% 27
          28                                                                                                                                                                                                                                                                                  28
          29       B8.      Household Income (Schedule HI-144, Line z) .                                                                                                                                                       Check here if amended Schedule                                 29
                                                               You MUST attach Schedule HI-144  . . . . . . . . . . . . . . . . . . . . . . . . . . . .B8.  _____________________123456    .00                           X     HI-144, Household Income, is included.
          30                                                                                                                                                                                                                                                                                  30
          31     Complete the following ONLY if applicable from Form LRC-147, Part B .                                                                                                                                                                                                        31
          32                                                                                                                                                                                                                                                                                  32
                   B9.
          33                                                                1234567489012  For Profit Mobile Home Lot Rent (Allocable Rent from Form LRC-147)   . . . . . . . . . . . . . . . . . . . . . . . . .  .B9. __________________________.00                                         33
          34                                                                                                                                                                                                                                                                                  34
          35                                                                                                                                                                                                                                                                                  35
          36     Not-For-Profit Mobile Home Park, Cooperative, and Land Trust                                                                                                                                                                                                                 36

                   B10. 
          37                                                                1234567489012Allocated Education Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B10..__________________________.00            37
          38                                                                                                                                                                                                                                                                                  38
          39     B11.                                                           1234567489012 Allocated Municipal Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B11..__________________________.00       39
          40                                                                                                                                                                                                                                                                                  40
          41                                                                                                                                                                                                                                                                                  41
                  
          42     OR Property Tax from contiguous property if housesite has less than 2 acres                                                                  (See instructions.)                                                                                                             42

                   B12. 
          43                                                                1234567489012Contiguous property Education Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B12..__________________________.00                    43
          44                                                                                                                                                                                                                                                                                  44
                   B13. 
          45                                                                1234567489012Contiguous property Municipal Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B13..__________________________.00                    45
          46                                                                                                                                                                                                                                                                                  46
          47                                                                                                 MAXIMUM CREDIT AMOUNT IS $8,000.                                                                                                                                                 47
          48                                                                                                                                                                                                                                                                                  48
                 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 
          49     belief, they are true, correct, and complete. Preparers cannot use return information for purposes other than preparing returns.                                                                                                                                             49
          50                                                                                                                                                                                                                                                                                  50
                    Signature                                                                                                                                                     Date (MMDDYYYY)                                       Daytime Telephone Number
          51                                                                                                                                                                                                                                                                                  51
          52                                                                                                                                                                                                                                                                                  52
                                                                MMDDYYYY      123-213-1234
          53        Signature (If a joint return, BOTH must sign.)                                                                                                                Date (MMDDYYYY)                                       Daytime Telephone Number                              53
          54                                                                                                                                                                                                                                                                                  54
          55                                                                                                                                                                                                                                                                                  55
                                                                MMDDYYYY      123-213-1234
          56        Paid Preparer’s Signature                                                                                                                                     Date (MMDDYYYY)                                       Preparer’s Telephone Number                           56
          57                                                                                                                                                                                                                                                                                  57
          58                                                                                                                                                                                                                                                                                  58
                                                                MMDDYYYY      123-213-1234
          59        Firm’s Name (or yours if self-employed) and address                                                                                                           Preparer’s SSN or PTIN                                FEIN                                                  59
          60                                                                                                                                                                                                                                                                                  60
                   12345678901234567890123456789012345678       123456789       123456789
          61                                                                                                                                                                                                                                                                                  61
                                                                                                                                                                                                                               2024 Form HS-122
          62                     X Check if the Department of Taxes may discuss this return with the preparer shown.                                                                                                                                                                          62
                                                                                                                                                                                                                                              Page 2 of 2
          63                            5454                                                                                                                                                                                                     Rev. 10/23                                   63
 0  0  0  0 640  0  0  0  0 1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                                64
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          65                                                                                                                                                                                                                                                                                  65
          66                                                                                                                                                                                                                                                                                  66

          1                                                                                                                                                                                                                                                                         1
 0  0  0  0 20  0  0  0  0  1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                      2
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          3                                                                                                                                                                                                                                                                         3
          4                    Vermont Department of Taxes                                                                                                                                                                                                                          4
          5                                                                                                                                                                                                                                                                         5
          6                    2023 Schedule HI-144                                                                                                                                                *231441100*                                                                      6
          7                                                                                                                                                                                                                                                                         7
                                        Household Income                                                           Please PRINT in BLUE or BLACK INK                                               * 23 1441100*
          8                       For the year Jan. 1 - Dec. 31, 2023                                                                                                                                                                                                               8  Page 31
          9                                                                                                                                                                                                                                                                         9
          10     This schedule must be included with the 2024 Property Tax Credit Claim (Form HS-122) .  Please read instructions before completing schedule .                                                                                                                      10
          11                            Claimant’s Last Name                                                                         First Name                                                    MI                    Claimant’s Social Security Number                          11
          12                                                                                                                                                                                                                                                                        12
                   12345678901234567      12345678901234567    1     123456789
          13                   Spouse’s/CU Partner’s Last Name                                                                       First Name                                                    MI                    Claimant’s Date of Birth (MMDDYYYY)                        13
          14                                                                                                                                                                                                                                                                        14
                   12345678901234567      12345678901234567    1     MMDDYYYY
          15                                                                                                                                                                                                                                                                        15
          16     List the names and Social Security Numbers of all other people (in addition to a Spouse or CU Partner) who had income and lived with you during                                                                                                                    16
          17     2023 . Include both their taxable and non-taxable income in Column 3 . If you have more than two “Other People” living in your household, record the                                                                                                               17
          18     names and Social Security Numbers on a separate sheet of paper and include with the filing .                                                                                                                                                                       18
          19     X Check this box if you temporarily hosted a refugee, asylee, or asylum seeker in your home during 2023 .  Do not include their income on this form .                                                                                                              19
          20                                                                                                                                                                                                                                                                        20
          21                      Other Person #1 Last Name                                                                          First Name                                                    MI                    Other Person #1 Social Security Number                     21
          22                                                                                                                                                                                                                                                                        22
                   12345678901234567      12345678901234567    1     123456789
          23                      Other Person #2 Last Name                                                                          First Name                                                    MI                    Other Person #2 Social Security Number                     23
          24                                                                                                                                                                                                                                                                        24
                   12345678901234567      12345678901234567    1     123456789
          25                                                                                                                                                                                                                                                                        25 FORM  (Place at FIRST page)
                                     Yearly totals of ALL                                                                                                                                                                                                                              Form pages 
          26                                                                                                                                     1. Claimant /Claimant                                          2. Filing separately                          Other People          26
          27                   members of the household                                                                                       and jointly filed Spouse                                          Spouse or CU Partner                3.                              27
          28                                                                                                                                                                                                                                                                        28
          29                                             a. Cash public assistance and relief (See instructions for exclusions)   . . .a. ____________123456      .00                                            ____________123456      .00       ___________123456.00             29
          30                                                                                                                                                                                                                                                                        30
                  b.   Social Security, SSI, disability, railroad retirement,  
          31                                            veteran’s benefits, taxable and nontaxable  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . b..  . 123456      .  .  .  .  .   ____________.00               ____________123456      .00       ___________123456.00             31 31 - 32
          32                                                                                                                                                                                                                                                                        32
          33                                             c. Unemployment compensation/worker’s compensation  . . . . . . . . . . . . .c. ____________123456      .00                                             ____________123456      .00       ___________123456.00             33
          34                                                                                                                                                                                                                                                                        34
                  d.   Wages, salaries, tips, etc . (See instructions for  
          35                                            dependent’s exempt income .)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . d..  .  . 123456      .  .  .  .  .  .  . .00.   ____________  ____________123456      .00     ___________123456.00             35
          36                                                                                                                                                                                                                                                                        36
          37                                             e. Interest and dividends  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . e..  . 123456      .  .  .  .  .  .  . .00.  .  .   ____________ ____________123456      .00  ___________123456.00 37
          38                                                                                                                                                                                                                                                                        38
                   f.  Interest on U .S ., state, and municipal obligations,  
          39                                            taxable and nontaxable   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . f..  . 123456      .  .  .  .  .  .  . .00.  .  .  .  ____________ ____________123456      .00  ___________123456.00     39
          40                                                                                                                                                                                                                                                                        40
          41                                             g. Alimony and support money  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . g..  . 123456      .  .  .  .  .  .  . .00.  .   ____________  ____________123456      .00  ___________123456.00            41
          42                                                                                                                                                                                                                                                                        42
                  h.   Child support and cash gifts
          43                                                                                                                                                                                                                                                                        43
          44                 Please specify__________________________  ABCDEFGHIJKLMNOP             . . . . . . . . . . . . . . . . . .          h. ____________123456      .00                                  ____________123456      .00       ___________123456.00             44
          45                                                                                                                                                                                                                                                                        45
                   i.  Business income . If the amount is a loss, enter -0- .  
          46                                            See instructions for offsetting a loss   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . i..  . 123456      .  .  .  .  .  .  . .00.  ____________  ____________123456      .00       ___________123456.00             46
          47                                                                                                                                                                                                                                                                        47
                   j.  Capital gains, taxable and nontaxable . If the amount is a loss,  
          48                                            enter -0- .  See instructions for offsetting a loss   . . . . . . . . . . . . . . . . . . j..  ____________123456      .00                               ____________123456      .00       ___________123456.00             48
          49                                                                                                                                                                                                                                                                        49
                  k.   Taxable pensions, annuities, IRA and other retirement fund and  
          50                                            distributions . See instructions   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . k..  . 123456      .  .  .  .  .  .  . .00.  .   ____________ ____________123456      .00  ___________123456.00            50
          51                                                                                                                                                                                                                                                                        51
                   l. Rental and royalty income . If the amount is a loss, enter -0- .  
          52                                            See instructions for offsetting a loss  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . l..  . 123456      .  .  .  .  .  .  . .00____________   ____________123456      .00       ___________123456.00             52
          53                                                                                                                                                                                                                                                                        53
          54       m.  Farm/partnerships/S corporations/LLC/Estate or Trust income .                                                                                                                                                                                                54
                       If the amount is a loss, enter -0- . See Line m instructions for only  
          55                                            exception to offset a loss  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . m..  ____________. 123456      .  .  .  .  .  .  .  . .00.  .  ____________123456      .00  ___________123456.00         55
          56                                                                                                                                                                                                                                                                        56
                  n.   Other income (See instructions for examples of other income)
          57                                                                                                                                                                                                                                                                        57
          58                 Please specify__________________________  ABCDEFGHIJKLMNOP             . . . . . . . . . . . . . . . . . .          n. ____________123456      .00                                  ____________123456      .00       ___________123456.00             58
          59                                                                                                                                                                                                                                                                        59
          60                                             o. Total Income: ADD Lines a through n  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . o..  _____________. 123456      .  .  .  .         .00           _____________123456      .00      _____________123456.00           60
          61                                                                                                                                                                                                                                                                        61
                                                                                                                                                                                                                                 2023 Schedule HI-144
          62                                                                                                                                                                                                                                                                        62
                                                                                                                                                                                                                                                  Page 1 of 2
          63                            5454                                                                                                                                                                                                      Rev. 10/23                        63
 0  0  0  0 640  0  0  0  0 1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                      64
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          65                                                                                                                                                                                                                                                                        65
          66                                                                                                                                                                                                                                                                        66

          1                                                                                                                                                                                                                                                                            1
 0  0  0  0 20  0  0  0  0    1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                       2
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
          3                                                                                                                                                                                                                                                                            3
          4                                              Claimant’s Last Name                                     Social Security Number                                                                                                                                               4
          5                                                                                                                                                                                                                                                                            5
                         12345678901234567    123456789
          6                                                                                                                                                                         *231441200*                                                                                        6
          7                                                                                                                                                                                                                                                                            7
                                                                                                                                                                                    * 23 1441200*
          8                                                                                                                                                                                                                                                                            8  Page 32
          9                                    Carried forward from Line o                  . . . . . . _____________123456      .00                   _____________123456      .00                    _____________123456.00                                                          9
          10                                                                                                                                                                                                                                                                           10
          11                                                                                                                                                                                                                                                                           11

          12                                                                                             1. Claimant /Claimant                           2. Filing separately                               Other People                                                               12
          13      p.   See instructions . Enter Social Security and                                                                                                                                      3.                                                                            13
                       Medicare tax withheld on wages claimed on                                      and jointly filed Spouse                        Spouse or CU Partner
          14           Line d .  Self-Employed: Enter self-employment                                                                                                                                                                                                                  14
          15           tax from federal Schedule SE . This entry may                                                                                                                                                                                                                   15
          16           differ from W-2/1099 or federal Schedule SE                                                                                                                                                                                                                     16
          17           amount if these taxes are paid on income not                                                                                                                                                                                                                    17
          18           required to be reported on Schedule HI-144 .                                                                                                                                                                                                                    18
                       Include W-2 and/or federal Schedule SE  
          19                               if not included with income tax filing  . . . . .p.        ____________123456      .00                      ____________123456      .00                     ____________123456.00                                                           19
          20                                                                                                                                                                                                                                                                           20
                  q.   Child support paid .  You must include  
          21                               proof of payment . See instructions  . . . . . . .q.       _____________123456      .00                     _____________123456      .00                    _____________123456       .00                                                   21
          22                                                                                                                                                                                                                                                                           22
                  
          23                     Support paid to:  Last Name                                                                           First Name                                         MI                                  Social Security Number                                   23
          24                                                                                                                                                                                                                                                                           24
                  12345678901234567        12345678901234567     1   123456789
          25                                                                                                                                                                                                                                                                           25 FORM  (Place at LAST page)
          26      r. Allowable adjustments from federal Form 1040                                                                                                                                                                                                                      26 Form pages 
          27                                  r1.  Business expenses for Reservists   . . . r1..          ___________123456      .00                   ____________123456      .00                     ____________123456.00                                                           27
          28                                                                                                                                                                                                                                                                           28
          29                                  r2.  Alimony paid   . . . . . . . . . . . . . . . . . . r2.. ___________123456      .00                  ____________123456      .00                     ____________123456.00                                                           29
          30                                                                                                                                                                                                                                                                           30
                     r3.  Self-employed health  
          31                                  insurance deduction  . . . . . . . . . . . . . . r3..       ___________123456      .00                   ____________123456      .00                     ____________123456.00                                                           31 31 - 32
          32                                                                                                                                                                                                                                                                           32
          33                                   r4.  Health Savings Account deduction  . . r4..            ___________123456      .00                   ____________123456      .00                     ____________123456.00                                                           33
          34                                                                                                                                                                                                                                                                           34
                  s. ADD Lines p, q, and total of   
          35                               Lines r1 through r4 for each column  . . . . s..  ___________123456      .00                                ____________123456      .00                     ____________123456.00                                                           35
          36                                                                                                                                                                                                                                                                           36
                   t. SUBTRACT Line s from Line o of each 
          37                               column. If a negative amount, enter -0-  .  . . t..  ___________123456      .00                             ____________123456      .00                     ____________123456.00                                                           37
          38                                                                                                                                                                                                                                                                           38
          39                                                                       123456u. ADD all three amounts from Line t. If a negative amount, enter -0-   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u..  ___________                .00 39
          40                                                                                                                                                                                                                                                                           40
          41      v. Complete if born Jan . 1, 1959 and after .                                                                                                                                                                                                                        41
                       Enter interest and dividend income from  
          42                               Lines e and f .  . . . . . . . . . . . . . . . . . . . . . . . . v..   ___________123456      .00           ____________123456      .00                     ____________123456.00                                                           42
          43                                                                                                                                                                                                                                                                           43
          44                                                                       123456w. ADD all three amounts from Line v  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .w. ___________ .00 44
          45                                                                                                                                                                                                                                                                           45
          46      x.   Asset Adjustment of Interest and Dividend Income (Lines e and f) .  Per 32 V .S .A . § 6061E  . . . . . . . . . . . . . . . . . . . . . . . .  . x.  _______________10,000.00                                                                                   46
          47                                                                                                                                                                                                                                                                           47
          48                                                                       123456y. SUBTRACT Line x from Line w. If Line x is more than Line w, enter -0-   .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . y..  ___________                      .00 48
          49                                                                                                                                                                                                                                                                           49
          50                                                                       123456z. HOUSEHOLD INCOME. ADD Line u and Line y  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . z.___________                   .00 50
          51                                                                                                                                                                                                                                                                           51
          52                                                                                                                                                                                                                                                                           52
          53     HOMEOWNERS                     Form HS-122, Homestead Declaration AND Property Tax Credit Claim, must be filed each year .                                                                                                                                            53
          54                                    Homeowners with Household Income up to $128,000 on Line z should complete Form HS-122, Section B . You may be eligible for                                                                                                             54
          55                                             a property tax credit . Schedule HI-144 must be filed with Form HS-122 .                                                                                                                                                      55
          56                                    The due date to file Form HS-122 is April 15, 2024 . Homeowners filing a property tax credit, Form HS-122, Section B, and                                                                                                              56
          57                                             Schedule HI-144, between April 16 and Oct . 15, 2024, may still qualify for a Property Tax Credit .  A $15 late filing fee will be                                                                                            57
                                                         deducted from the credit . Generally, claims cannot be accepted after Oct . 15, 2024 .
          58                                                                                                                                                                                                                                                                           58
          59                                                                                                                                                                                                                                                                           59
          60                                                                                                                                                                                                                                                                           60
          61                                                                                                                                                                                                               2023 Schedule HI-144                                        61
          62                                                                                                                                                                                                                                    Page 2 of 2                            62
          63                              5454                                                                                                                                                                                                     Rev. 10/23                          63
 0  0  0  0 640  0  0  0  0   1  1  1  1  1  1  1  1  1  1  2  2  2  2  2  2  2  2  2  2  3  3  3  3  3  3  3  3  3  3  4  4  4  4  4  4  4  4  4  4  5  5  5  5  5  5  5  5  5  5  6  6  6  6  6  6  6  6  6  6  7  7  7  7  7  7  7  7  7  8  8  8  8  8  8  8                       64
 1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5  6  7  8  9  0  1  2  3  4  5
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