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Vermont Domicile Statement (Property Tax Homestead Declaration)
Extracted from PDF file 2023-vermont-domicile-statement.pdf, last modified April 2019Domicile Statement (Property Tax Homestead Declaration)
Vermont Department of Taxes Phone: (802) 828-2865 133 State Street Montpelier, VT 05633-1401 For Department Use Only DOMICILE STATEMENT For the taxable year ending ____________________ Unless otherwise indicated, the questions pertain to the year specified above. Your Name Social Security Number Spouse / CU Partner Name Spouse / CU Partner Social Security Number VERMONT Address Other Address City, State, ZIP Code City, State, ZIP Code Email Address Telephone Number 1. Have you ever resided in Vermont with the intention of making it your home? If Yes, when did you take up residency in Vermont (month/year)? _________________________________________ If No, please explain your connections with the State of Vermont (place of birth, school attendance, etc.).__________ ______________________________________________________________________________________ ______________________________________________________________________________________ 2. If you once resided in Vermont, did you leave not intending to return and did you take up residence in another state with the intention of making that state your home? Never resided in Vermont. Go to Question 3. No. Go to Question 3. Yes. 2a. Date you moved from Vermont _________________________________________________________ 2b. Address to which you moved ___________________________________________________________ 2c. Date on which you took up residence in the new state________________________________________ 2d. What specific steps did you take to abandon your legal residence in Vermont?_____________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2e. What specific steps did you take to establish your new legal residence (examples: drivers license, voter registration, vehicle registration)?________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 3. Did you reside in two or more homes during the year? No. Go to Question 4. Yes. Please state the address and dates on which you were physically present in each location: Total number Physical Address (street, city, state) Periods (Dates) of days _________________________________________________ ____________________________ ___________ _________________________________________________ ____________________________ ___________ _________________________________________________ ____________________________ ___________ Domicile Statement Page 1 of 3 Rev. 04/19 Your Name Social Security Number For the taxable period ending 4. Do you own or rent a house or apartment? No. Go to Question 5. Yes. Property Value # of days spent Physical Address Own/Rent (if owned) here last year 4a. ______________________________________________ _________ _______________ ________________ 4b. ______________________________________________ _________ _______________ ________________ 4c. ______________________________________________ _________ _______________ ________________ 5. Where do members of your immediate family live (spouse or CU partner, children)?___________________________ ______________________________________________________________________________________________ 6. If married or civil union, did the physical presence of your spouse/partner and family differ substantially from yours? Single No Yes. Please explain and attach a separate Domicile Statement for your spouse/CU partner. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 7. Did you claim a homestead property tax exemption for any state? No. Go to Question 8. Yes. What state(s)?___________________________________________________________________________ 8. Where are the items or possessions that you consider important to you located, e.g.: items of significant sentimental value, family heirlooms, collections of valuables, pets, or possessions that enhance the quality of your life? Item/Possession Location _________________________________ __________________________________________________________ _________________________________ __________________________________________________________ _________________________________ __________________________________________________________ _________________________________ __________________________________________________________ 9. In what State(s) did you or your Spouse/CU Partner perform services for compensation (work)? State Employer Date of Employment Self: ________________ ________________________________________________________ ___________________ ________________ ________________________________________________________ ___________________ ________________ ________________________________________________________ ___________________ Spouse or CU Partner: ________________ ________________________________________________________ ___________________ ________________ ________________________________________________________ ___________________ ________________ ________________________________________________________ ___________________ 10. Do you own any part of a business? No. Go to Question 11. Yes. 10a. Where is the business located? _________________________________________________________ 10b. What is your ownership percentage?_____________________________________________________ Domicile Statement Page 2 of 3 Rev. 04/19 Your Name Social Security Number For the taxable period ending 11. Where did your children attend school? List name and address of school(s). _________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 12. What address did you use for mailing purposes and why?________________________________________________ ______________________________________________________________________________________________ 13. What address did you use on your federal tax return(s) and why?__________________________________________ ______________________________________________________________________________________________ 14. Please list the state(s), if any, with which you filed income tax return(s) for the taxable year and enclose a copy of the return(s)_______________________________________________________________________________________ 15. During the taxable year, did you have: State(s) a. A House or Apartment. . . . . . . . . . . . . . . . . . . . . . . . . . . . No b. Vacation House . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No c. Driver’s License (attach copy). . . . . . . . . . . . . . . . . . . . . . No d. Automobile/Power Boat/Snow Machine Registration. . . . No e. Aircraft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No f. Voting Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No g. Bank Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No h. Resident Hunting and Fishing Licenses. . . . . . . . . . . . . . . No i. Golf Club/Rod & Gun Club Membership(s). . . . . . . . . . . No j. Location of Doctor and Medical Records. . . . . . . . . . . . . No Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes _______________________ Yes_______________________ k. Civic, religious, or community clubs or activities. . . . . . . No [List Organization(s) AND State(s)]_____________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 16. Are you a member of the Armed Services?. . . . . No. Skip Question 17 and go to Question 18. Yes, Active Duty Yes, Reserve 17. Did you enter the service from Vermont?. . . . . . No Yes 18. You may use this space, or attach a separate page to explain your answers or to make any additional statements that could help us in arriving at a proper conclusion._____________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Under penalties of perjury, I declare that I have examined this document and accompanying statements, and to the best of my knowledge and belief, they are true, correct and complete. Taxpayer’s Signature Date Daytime Telephone Number Spouse’s Or CU Partner’s Signature Date Daytime Telephone Number Domicile Statement Page 3 of 3 Rev. 04/19 Clear ALL fields Save and go to Important Printing Instructions Save and Print
Domicile Statement
More about the Vermont Domicile Statement Other TY 2023
We last updated the Domicile Statement (Property Tax Homestead Declaration) in February 2024, so this is the latest version of Domicile Statement, fully updated for tax year 2023. You can download or print current or past-year PDFs of Domicile Statement directly from TaxFormFinder. You can print other Vermont tax forms here.
Other Vermont Other Forms:
TaxFormFinder has an additional 51 Vermont income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form HS-122, HI-144 | Homestead Declaration AND Property Tax Adjustment Claim |
| Form RCC-146 | Vermont Renter Credit Claim |
| Form LRC-140 | Landlord Certificate (Form LRC-140) |
| Form 8821-VT | Authorization To Release Tax Information |
| Domicile Statement | Domicile Statement (Property Tax Homestead Declaration) |
View all 52 Vermont Income Tax Forms
Form Sources:
Vermont usually releases forms for the current tax year between January and April. We last updated Vermont Domicile Statement from the Department of Taxes in February 2024.
Historical Past-Year Versions of Vermont Domicile Statement
We have a total of three past-year versions of Domicile Statement in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
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