Get VT LC-142 2019-2024

Vermont. gov. Use this E-file Certificate Number. Section C Signature I certify the rental information on this Landlord s Certificate is to the best of my knowledge and belief true correct and complete. Signature of landlord or authorized representative Save and go to Important Printing Instructions Date Daytime Telephone Number Form LC-142 Rev. 10/16 Save and Print. Clear tenant names Section B Clear all except Landlord info Clear ALL data 161421100 VT Landlord s Certificate LC-142 FORM CLAIMANT Remember to enter your Social Security Number when you file the rebate claim. Claimant s Last Name First Name Initial Claimant s Social Security Number Section A Landlord and Rental Unit Information Name of Owner or Landlord Landlord s Mailing Address City State ZIP Code Location of Rental Unit number street/road name SPAN from property tax bill City / Town Number of Units in this Building Rental Unit is check one Nursing Home / Apartment House Lot for Mobile Home Mobile Home Boarding Home Community Care c c Electricity c Personal Care c Other Services Items Included in Rent check all that apply c Heat c Furnishings Tenant 1 Last Name Section B Allocable Rent 1. Calendar year. 1a* Number of months rented*. 1b. 2. Monthly rental amount paid. 2. 3. Total Rent Paid for calendar year listed on Line 1a*. 3. 4. Less dollar value of items checked in Box 6 above that were included in rent heat electricity etc*. 4. 5. Adjusted rent paid for calendar year listed on Line 1a Line 3 minus Line 4. 5. 100. 00. 6. For government subsidized rent enter percent tenant pays. For nonsubsidized rent enter 100. 00. 6. 7. Rent Paid during calendar year solely for the right of occupancy Multiply Line 5 by Line 6. 7. 21. 00 8. Rental Adjustment. 8. 9. ALLOCABLE RENT Multiply Line 7 by Line 8. 9. RENTERS Enter on Form PR-141 Line 3. MOBILE HOME OWNERS Enter on Form HS-122 Line B10. FILE ONLINE File your claim online at www. myVTax. Calendar year. 1a* Number of months rented*. 1b. 2. Monthly rental amount paid. 2. 3. Total Rent Paid for calendar year listed on Line 1a*. 3. 4. Less dollar value of items checked in Box 6 above that were included in rent heat electricity etc*. 3. 4. Less dollar value of items checked in Box 6 above that were included in rent heat electricity etc*. 4. 5. Adjusted rent paid for calendar year listed on Line 1a Line 3 minus Line 4. 5. 100. 00. 6. For government subsidized rent enter percent tenant pays. 4. 5. Adjusted rent paid for calendar year listed on Line 1a Line 3 minus Line 4. 5. 100. 00. 6. For government subsidized rent enter percent tenant pays. For nonsubsidized rent enter 100. 00. 6. 7. Rent Paid during calendar year solely for the right of occupancy Multiply Line 5 by Line 6. For nonsubsidized rent enter 100. 00. 6. 7. Rent Paid during calendar year solely for the right of occupancy Multiply Line 5 by Line 6. 7. 21. 00 8. Rental Adjustment. 8. 9. ALLOCABLE RENT Multiply Line 7 by Line 8. 9. RENTERS Enter on Form PR-141 Line 3. 7. 21. 00 8. Rental Adjustment. 8. 9. ALLOCABLE RENT Multiply Line 7 by Line 8. 9. RENTERS Enter on Form PR-141 Line 3. MOBILE HOME OWNERS Enter on Form HS-122 Line B10. FILE ONLINE File your claim online at www. myVTax.