Form IN-111 Fillable Vermont Income Tax Return

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00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0010 check indicate indicate (: CU Joint) Unchecked (: CU Separate) Unchecked (: Head of Household) Unchecked (: Joint) Unchecked (: Married Separate) Unchecked (: Single) Unchecked (: Widow) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear ALL data fields) Clear ALL fields (Click here for printing instructions) Important Printing Instructions (Enter just the 9 digits no hyphens or spaces) (Enter Spouse or CU Partner's name ONLY if filing separately) (Enter the 3 digit School Code) (Enter the 5 digit ZIP Code) (Enter the number of exemptions claimed) (If you are filing separately Enter just the 9 digits of the Spouse or CU partner no hyphens or spaces) (Middle Initial) (Print) Print (Schedule IN 117 Line 21) (See instructions on page 9) 31g (Spouse/CU Partner's Middle Initial) (Subtract Line 14d from Line 13 If Line 14d is more than Line 13 enter zero ) 15 (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 0 *131111100* *131111200* 1 Taxpayer s Last Name 1 VT School Code 1040EZ Line 6) If the Federal amount is zero see instructions on page 6 12a Income from Non VT State and Local Obligations (Schedule IN 112 Part I Line 3) 12a 12b Bonus Depreciation allowed under Federal law for 2013 12c Addback of State and Local Income Taxes (Schedule IN 154 Line 10) 13 FEDERAL TAXABLE INCOME WITH ADDITIONS (Add Lines 11 12a 12b and 12c) 14a Interest Income from U S Obligations 14b Capital Gains Exclusion (Schedule IN 153 Line 21) 14b 14c Adjustment for prior years Bonus Depreciation 14c 14d Add Lines 14a 14b and 14c 14d 17 ADDITIONS TO VT INCOME TAX (Schedule IN 112 Part II Line 7) 17 17Form IN 111* 18 VT INCOME TAX WITH ADDITIONS (Add Lines 16 & 17) 18 19 SUBTRACTIONS FROM VT INCOME TAX (Schedule IN 112 Part II Line 15) 19 2 911 street address on 12/31/2013 Number street/road name (Do not use PO Box same or Town name) 20 VT INCOME TAX (Subtract Line 19 from Line 18 If Line 19 is more than Line 18 enter zero) 20 23 24 25 26 VT INCOME TAX AFTER CREDITS (Subtract Line 25 from Line 22 If Line 25 is more than Line 22 enter zero ) 26 27 USE TAX (See page 8 for instructions and chart) 27 28 TOTAL VT TAXES (Add Lines 26 and 27) 28 29a 29b 29c 29d 3 Single 4 Head of 5 Married 6 CU Partner 7 Qualifying 30 TOTAL OF VT TAXES & VOLUNTARY CONTRIBUTIONS (Add Lines 28 and 29d) 30 31a From W 2 1099 etc VT Tax Withheld 31a 31b From VT Form IN 114 Estimated Tax for 2013 and/orForm IN 151 Extension with payment 31b 31c Earned Income Tax Credit (Schedule IN 112 Part III) 31c 31d Renter Rebate (Form PR 141 Line 9) 31d 31e From VT Form RW 171 VT Real Estate Withholding (seeinstructions on page 8) 31e 31f From VT Form WH 435 Estimated Income Tax Paymentmade by Business Entity for Nonresident Partner 31g Low Income Child & Dependent Care Credit 31h TOTAL PAYMENTS AND CREDITS (Add Lines 31a through 31g) 31h 32 OVERPAYMENT If Line 30 is less than Line 31h subtract Line 30 from Line 31h 32 33a REFUND TO BE CREDITED TO 2014 ESTIMATED TAX PAYMENT 33b REFUND TO BE CREDITED TO 2014 PROPERTY TAX BILL 33b 34 REFUND AMOUNT (Subtract Lines 33a and 33b from Line 32) 34 35 If Line 30 is more than Line 31h subtract Line 31h from Line 30 See page 9 for instructions on tax due 35 37 Add Lines 35 5454To claim refund mail to: 8a Married 8b CU ADDITIONS: ADJUSTED GROSS INCOME (Federal Form 1040 Line 37; 1040A Line 21; 1040EZ Line 4) ADJUSTED VT INCOME TAX (Multiply Line 20 by Line 21) Amount on 31d cannot be credited to 2014 estimated tax payment 33a an AMENDED return and 36 37 and belief they are true correct and complete Preparers cannot use return information for purposes other than preparing returns cc++= Check here if authorizing the VT Department of Taxes to discuss this return and attachments with your preparer Check here if this is Check here if using RECOMPUTED Check here to certify that no Use Tax is due Check if age65 or older Check if Spouse or CU Partner Check if taxpayer Check to Check to Continued on back Continued on back Contributions CREDIT FOR INCOME TAX PAID TO OTHER VT TAX CREDITS (Schedule IN 112 TOTAL VT CREDITS Credits and Use Tax CU Partner full name died during 2013 DUE DATE: April 15 2014 Please PRINT in BLUE or BLACK INK DEPT USE ONLY Enter amount from Line 22 Enter Spouse or Estimated Tax (Worksheet IN 152 or 152A) EXEMPTIONS CLAIMED (Federal Form 1040 Line 6d; 1040A Line 6d; 1040EZ/1040NR EZ enter 0 1 or 2) 9 Federal Return information FEDERAL TAXABLE INCOME (Federal Form 1040 Line 43; 1040A Line 27; Filing Filing Enter Spouse or CU Partner FILING STATUS Firm s name (or yours if self employed) and address EIN First Name For amended Form IN 111 Form IN 111 page 2 of 2 Household Filing Filing Widow(er) with If negative IN 111 INCOME ADJUSTMENT (Schedule IN 113 Line 43 OR 100 00%) 21 Income Tax Return 2013 Initial Interest and Penalty on Underpayment of Jointly Jointly dependent children Keep a copy for your records Mailing Address (Number and Street/Road or PO Box) Member or Shareholder (see page 9) 31f Nongame Wildlife Fund Children s Trust Fund VT Veterans Fund Original refund received Refund due now Original payment Amount due now Payments and Credits Preparer s Preparer s signature Date Preparer s Preparer s Telephone Number Refund returns only Separately Separately Social Security Number Signature Date Occupation Telephone Number Signature If a joint return BOTH must sign Date Occupation Signatures Spouse or CU Partner Social Security Number SSN or Staple W 2/1099s here State STATE OR CANADIAN PROVINCE Part IV Line 6 OR Schedule IN 119) (Add Lines 23 and 24) SUBTRACTIONS: Tax Filing Information2 Taxable Income Taxpayer InformationSpouse or CU Partner Last Name Taxpayer s Social Security Number Under penalties of perjury I declare that I have examined this return and accompanying schedules and statements and to the best of my knowledge Use Only VERMONT VT Department of Taxes PO Box 1779 Montpelier VT 05601 1779 VT Department of Taxes PO Box 1881 Montpelier VT 05601 1881 VT Income Tax VT INCOME TAX FROM VT TAX TABLE OR TAX RATE SCHEDULE on Line 15 amount 16 VT TAXABLE INCOME With payment mail to: ZIP Code

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