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          3                                                                                                                                                                                                                                                              3
          4                     Vermont Department of Taxes                                                                                                                                                                                                              4
          5                                                                                                            For the year                                                                                                                                      5
                                                                                                                   Jan. 1 - Dec. 31, 
          6                       2023 Form RCC-146                                                                         2023                                                  *231461100*                                                                            6
          7                                                                                                                                                                                                                                                              7
                            Vermont Renter Credit Claim                                                                                                                           * 23 1461100*
          8                                                                                                                                                                                                                                                              8  Page 27
          9                             Claimant’s Last Name                                                                   First Name                                         MI                            Claimant’s Social Security Number                        9
          10                                                                                                                                                                                                                                                             10
                   12345678901234567      12345678901234567    1   123456789
          11                    Spouse’s/CU Partner’s Last Name                                                                First Name                                         MI                Spouse’s or CU Partner’s Social Security Number                      11
          12                                                                                                                                                                                                                                                             12
                   12345678901234567      12345678901234567    1   123456789
          13                                              Mailing Address (Number and Street/Road or PO Box)                                                                                              Claimant’s Date of Birth (MM/DD/YYYY)                          13
          14       123456789012345678901234567890123456               MM /       DD /                                                                                                                                                   YYYY                             14
          15                                           City                                            State                                     ZIP Code                                                                County of Rental Unit                           15 FORM  (Place at FIRST page)
          16       123456789012345678901   12   1234567890         12345678901234567890                                                                                                                                                                                  16 Form pages 
          17        Vermont School District Code                            Physical Address of Rental Unit on 12/31/2023                                                   Unit                    City/Town of Rental Unit on 12/31/2023                    and  State 17
          18                                                                                                                                                                                                                                                             18
                     123       123456789012345678901234567  12345  123456789012345678   12
          19           Federal                                                                                                                                                                Will you be using Renter Credit                                            19
                                                                                        Filing Jointly                      Filing Separately                   Household
          20                  Filing Status         X        Single               X        Married/CU                  X        Married/CU                X                      Head of      to pay Income Tax liability?                       X    Yes     X     No   20
          21                                                                                                                                                                                                                                                             21
                                                                                                                                                                                                                                                                            27 - 27
               1.  SPAN
          22                                                          .  To find your SPAN, please see instructions. .................................                                  1.  ______________________________________123  - 123  -     12345                22
          23 To determine eligibility, answer questions 2 through 4.                                                                                                                                                                                                     23
          24                                            2.  Were you domiciled in Vermont all of calendar year 2023?  .......              2.          X                Yes, Go to Question 3.                           X     No, STOP.  You are not eligible.          24
          25                                                                                                                                                                                                                                                             25
               3.
          26                                              Were you claimed as a dependent by another taxpayer in 2023?  ...                3.          X                Yes, STOP.  You are not eligible.                X     No, Go to Question 4.                     26
          27                                                                                                                                                                                                                                                             27
               4.
          28                                              Did you rent in Vermont for six months or more in 2023?  ........                4.          X                Yes, Go to Question 5.                           X     No, STOP.  You are not eligible.          28
          29                                                                                                                                                                                                                                                             29
             If you are eligible for a Renter Credit, complete Lines 5 through 14.
               5.
          30                                                                       Did you share your rental unit with another adult who was not your jointly filed spouse? .......................                                  5.          X     Yes    X No       30
          31                                                                                                                                                                                                                                                             31
               6.
          32                                                                       Was your rent subsidized?  ........................................................................                                               6.          X     Yes    X No       32
          33                                                                                                                                                                                                                                                             33
                                     6a.   
          34                                                                           12If “Yes”, how many months was your rent subsidized in 2023? ..............................                                               6a.  ___________________               34
          35                                                                                                                                                                                                                                                             35
               7. 
          36                                                                           12Number of months rented in 2023  ..................................................................                                         7.  ___________________             36
          37                                                                                                                                                                                                                                                             37
          38   8.      Number of Personal Exemptions claimed (from Form IN-111, Line 5d)                                                                                                                                                                                 38
                                                                                123456789(See the instructions if you did not file Form IN-111) ...................................................                                  8.  ___________________
          39                                                                                                                                                                                                                                                             39
               9.
          40                                                                       Did you file a federal income tax return?  (See the instructions if you answered “No.”)  ........................                                 9.          X     Yes    X No       40
          41                                                                                                                                                                                                                                                             41
              10. 
          42                                                                   123456789Total Income (from federal Form 1040, Line 9) .......................................................                                     10.  _______________.00                42
          43                                                                                                                                                                                                                                                             43
          44  11.      75% of nontaxable Social Security benefits                                                                                                                                                                                                        44
                                                                               123456789(from federal Form 1040, Line 6a minus Line 6b.  Multiply result by 0.75) .................................                               11.  _______________.00
          45                                                                                                                                                                                                                                                             45
              12. 
          46                                                                   123456789Tax-exempt interest (from federal Form 1040, Line 2a) ................................................                                    12.  _______________.00                46
          47                                                                                                                                                                                                                                                             47
          48  13.      Add back any negative amounts from federal Form 1040, Line 7 and Schedule 1, Lines 3, 4, 5, 6, and 8a.                                                                                                                                            48
                                                                               123456789(See instructions)  ..............................................................................                                        13.  _______________.00
          49                                                                                                                                                                                                                                                             49
              14. 
          50                                                                   123456789Total (ADD Lines 10 through 13) .................................................................                                         14.  _______________.00                50
          51                                                                                                                                                                                                                                                             51
          52     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,                                                                            52
          53     correct, and complete. Preparers cannot use return information for purposes other than preparing returns.                                                                                                                                               53
          54        Signature                                                                                                                                                     Date (MM/DD/YYYY)                                     Daytime Telephone Number         54
          55                                                                                                                                                                                                                                                             55
                                                                MMDDYYYY      123-213-1234
          56        Signature (If a joint return, BOTH must sign.)                                                                                                                Date (MM/DD/YYYY)                                     Daytime Telephone Number         56 FORM  (Place at LAST page)
          57                                                    MMDDYYYY      123-213-1234                                                                                                                                                                               57 Form pages 
          58        Paid Preparer’s Signature                                                                                                                                     Date (MM/DD/YYYY)                                     Preparer’s Telephone Number      58
          59                                                                                                                                                                                                                                                             59
                                                                MMDDYYYY      123-213-1234
          60        Firm’s Name (or yours if self-employed) and address                                                                                                           Preparer’s SSN or PTIN                                FEIN                             60
          61                                                                                                                                                                                                                                                             61
                   12345678901234567890123456789012345678       123456789      123456789
          62                                                                                                                                                                                                                            Form RCC-146                     62 27 - 27
          63                     X5454                                   Check if the Department of Taxes may discuss this return with the preparer shown.                                                               Page 1 of 1, Rev. 10/23                         63
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