Form Lc-142 - Landlord'S Certificate - Vermont Department Of Taxes - 1999

VERMONT DEPARTMENT OF TAXES, Montpelier, Vermont 05609-1401/(802) 828-2865

Landlord’s Certificate

1999 VERMONT

Name of renter(s) ___________________________________________

Name of owner or landlord________________________________________

_______________________________________________________

Address____________________________________________________

Location of rental unit ________________________________________

_________________________________________________________

number, street/road name

_______________________________________________________

Landlord’s daytime phone number ___________________________________

city/town

A.

Check the type of unit rented:

Apartment

House

Lot for mobile home

Mobile home

Boarding home

Nursing home/community care

B.

Indicate which, if any, items were included in the rent:

Heat

Electricity

Furnishings

Personal Care

Other Services

C.

Town or city to which property tax on rental unit is paid:__________________________________________________

D.

Enter the number of rental units in this building _____________

1. Number of months rented during calendar year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. Monthly rental amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3. Total Rent Paid for calendar year 1999 (Multiply Line 1 by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

4. Less items checked in (B) above that were included in rent (heat, electricity, etc.) . . . . . . . . . . . . . . . . . . . . 4.

5. Adjusted rent paid for calendar year 1999 (Line 3 minus Line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

%

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.

2 1 0 0

%

8. Rental Adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.

9. Allocable Rent (Multiply Line 7 by Line 8) Enter here and on Form PR-141, Line 1 if Section B of this certificate is not completed.. . . . . . . . . 9.

Check the property tax allocation method you used for this rental. You must use the same method for every unit within the rental building.

a.

Number of rooms available

b.

Percentage of square footage

c.

Percentage of rent charged

d.

Separate appraisal

10. Calendar year property tax for unit occupied by above tenant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.

%

11. For government subsidized rent, enter percent tenant pays. For nonsubsidized rent, enter 100.00% . . . . 11.

12. Property tax allocated to rental unit for calendar year (Multiply Line 10 by Line 11). . . . . . . . . . . . . . . . . 12.

13. Monthly property tax: (Divide Line 12 by 12 months). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.

14. Allocable property tax: (Multiply Line 13 by Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.

15. Enter the LESSER of Line 7 or Line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.

16. Rent Constituting Property Taxes: Enter the GREATER of Line 9 or Line 15 here and on Form PR-141, Line 1 . . . . . . . . . . . . . . . . . . . . . . . 16.

Signature of landlord or authorized representative

Date

LANDLORDS: Vermont statute provides significant penalties for overstating the rental or allocable property tax amount and/or for failing to furnish this certificate to your tenant. Keep a

copy of this certificate for your records. For landlords with 4 or less total rental units, you are required to furnish a certificate only upon request by the tenant.

RENTERS: Attach your completed landlord’s certificate to your renter rebate claim form. For additional information on the rebate program, see Information for Renters on the other side of this form.

Form LC-142