Form CO-421 Fillable Unitary Affiliate Schedule
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$5 000 000 5862(c)) prepare a single Form CO 421 for the group (This Everywhere Initial Summary Vermont $1 650 $10 000 $10 001 $2 000 000 $2 000 001 $25 000 $25 001 $5 000 001 (attach (below) (Effective for taxable periods beginning January 1 2012) (Form (Form (Form (Multiply (PVC) (Subtract (VNOL) 05633 1401 133 State Street Montpelier VT 05633 1401 / (802) 828 5723 6 00% 7 00% 8 50% 828 2515 828 5723 828 5787 a single affiliate) within the VT unitary group (32 V S A above accounting Activity additional affiliate affiliate affiliate affiliate affiliate affiliate affiliate Affiliate Affiliate Provide Affiliate s Federal ID Number Affiliate s Name Affiliate s Primary 6 digit North American Industrial affiliates after all members of Allocated Allocated allocation American amount amount amount amount amounts amounts annual applied applied Apply Apportionable Apportioned apportionment Apportionment arrive assessed attach Attach to Form CO 411 U attributable availability available available BA 402 BA 402 BA 402 BA 402 BA 402 BA 404 basis basis ) being being below binding blue or black ink bottom boxes Bulletins calculate calculation cannot cannot carried carry carryover chart check Check if this CO 421 is being prepared for Classification Classification System (NAICS) Number clearly CO 411 U CO 411 U CO 411 U CO 421 CO 421 column Column combined Combined Commissioner company s Complete consolidated Consolidated Check CONTACTING THE DEPARTMENT conversion converted converted Corporate corporation Corporation corporations costs credit credit credits Credits decimal deduction demonstrate Department depends described described above detail detailing details Dividends documentation during electing to be treated as a single consolidated taxpayer (i e election Email Address: tax corpincome@state vt us Enter entity every every VT nexus everywhere excess expenses expiration factors factors Fax: (802) federal consolidated group (see instructions) filing first first in first out First prepare for multiple VT members of a federal consolidated group as Foreign Form CO 421 Instructions Unitary Affiliate Schedule forms Forms: (802) forward General Information generally gross Gross Gross group group group Group guidelines Header Information Identify identifying IF GROSS RECEIPTS ARE MINIMUM TAX IS IF VT NET INCOME IS TAX IS If VT nexus members of a federal consolidated group are Include included includes including income income income Income Income incurred Industrial information Initial instructions instructions instructions) liability Line 1 Apportionment Percentage Enter Line 10 Credits Report Line 11 Tax Due for this affiliate Subtract Line 12 Vermont Gross Receipts Enter Line 2 Group Apportionable Income Enter Line 3 Apportioned Income Multiply Line 4 Allocated Income Enter Line 5 Foreign Dividends Enter Line 6 Net VT Income Add Line 7 Cannot be greater than Line 6; VNOL cannot reduce Line 7 VT Net Operating Loss (VNOL) applied Enter Line 8 VT Net Taxable Income Subtract Line 9 Tax Apply Line by Line Instructions Lines Mailing address: member minimum minimum Minimum Montpelier NAICS Code Enter Name of Principal Vermont Corporation negative nexus North number offset operating Operating organization origin participating percentage percentage period permission Place an X in the box left of the line number to indicate a loss amount Enter all amounts in whole dollars places Please point pre 2007 Prepare prepared prepared prepared presence primary Principal Principal VT Corporation Federal ID Number Principal VT Corporation Provide print PRINT in BLUE or BLACK INK program program provide Provide Provide provided purpose PVC s rates receipts receipts Receipts received reduce reduce remaining repeat report required return Review right schedule schedule Schedule schedule) separate separate affiliate separately should sources specific Spreadsheet State statement statement/ Street subtracting System taken TAX COMPUTATION SCHEDULE taxable Taxes taxpayer Taxpayer Services: (802) taxpaying Technical total total track tracked tracking unitary Unitary until updating utilization Vermont Vermont Vermont Vermont Vermont Vermont VERMONT Unitary Affiliate Schedule FORM VT DEPARTMENT OF TAXES VT Net Taxable Income below 0 Water s Web site Address: http://tax vermont govincurred website which without worksheet would written www census gov/naics years years