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Vermont Department of Taxes
For the year
Jan. 1 - Dec. 31,
2023 Form RCC-146 2023 *231461100*
Vermont Renter Credit Claim * 23 1461100*
Page 27
Claimant’s Last Name First Name MI Claimant’s Social Security Number
12345678901234567 12345678901234567 1 123456789
Spouse’s/CU Partner’s Last Name First Name MI Spouse’s or CU Partner’s Social Security Number
12345678901234567 12345678901234567 1 123456789
Mailing Address (Number and Street/Road or PO Box) Claimant’s Date of Birth (MM/DD/YYYY)
123456789012345678901234567890123456 MM / DD / YYYY
City State ZIP Code County of Rental Unit FORM (Place at FIRST page)
123456789012345678901 12 1234567890 12345678901234567890 Form pages
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
123 123456789012345678901234567 12345 123456789012345678 12
Federal Will you be using Renter Credit
Filing Jointly Filing Separately Household
Filing Status X Single X Married/CU X Married/CU X Head of to pay Income Tax liability? X Yes X No
27 - 27
1. SPAN. To find your SPAN, please see instructions. .................................1. ______________________________________123 - 123 -12345
To determine eligibility, answer questions 2 through 4.
2. Were you domiciled in Vermont all of calendar year 2023? .......2. X Yes, Go to Question 3. XNo, STOP. You are not eligible.
3. Were you claimed as a dependent by another taxpayer in 2023? ...3. X Yes, STOP. You are not eligible. XNo, Go to Question 4.
4. Did you rent in Vermont for six months or more in 2023? ........4. X Yes, Go to Question 5. XNo, STOP. You are not eligible.
If you are eligible for a Renter Credit, complete Lines 5 through 14.
5. Did you share your rental unit with another adult who was not your jointly filed spouse? .......................5. X Yes X No
6. Was your rent subsidized? ........................................................................6. X Yes X No
12 6a. If “Yes”, how many months was your rent subsidized in 2023? ..............................6a. ___________________
7. 12Number of months rented in 2023 ..................................................................7. ___________________
8. Number of Personal Exemptions claimed (from Form IN-111, Line 5d)
123456789(See the instructions if you did not file Form IN-111) ...................................................8. ___________________
9. Did you file a federal income tax return? (See the instructions if you answered “No.”) ........................9. X Yes X No
10. 123456789Total Income (from federal Form 1040, Line 9) .......................................................10. _______________.00
11. 75% of nontaxable Social Security benefits
123456789(from federal Form 1040, Line 6a minus Line 6b. Multiply result by 0.75) .................................11. _______________.00
12. 123456789Tax-exempt interest (from federal Form 1040, Line 2a) ................................................12. _______________.00
13. Add back any negative amounts from federal Form 1040, Line 7 and Schedule 1, Lines 3, 4, 5, 6, and 8a.
123456789(See instructions) ..............................................................................13. _______________.00
14. 123456789Total (ADD Lines 10 through 13) .................................................................14. _______________.00
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct, and complete. Preparers cannot use return information for purposes other than preparing returns.
Signature Date (MM/DD/YYYY) Daytime Telephone Number
MMDDYYYY 123-213-1234
Signature (If a joint return, BOTH must sign.) Date (MM/DD/YYYY) Daytime Telephone Number FORM (Place at LAST page)
MMDDYYYY 123-213-1234 Form pages
Paid Preparer’s Signature Date (MM/DD/YYYY) Preparer’s Telephone Number
MMDDYYYY 123-213-1234
Firm’s Name (or yours if self-employed) and address Preparer’s SSN or PTIN FEIN
12345678901234567890123456789012345678 123456789 123456789
Form RCC-146 27 - 27
X5454 Check if the Department of Taxes may discuss this return with the preparer shown. Page 1 of 1, Rev. 10/23