Form Schedule IN-113 Fillable Income Adjustment Calculations
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

1 Wages salaries tips etc 1 1 2 Taxable interest 2 2 3 Ordinary dividends 3 3 4 Taxable refunds of state and local 5 Alimony received 5 5 6 Business income or loss 6 6 7 Capital gain or loss 7 7 8 Taxable IRA distributions 8 8 9 Taxable pensions and annuities 9 9 c VSAC c Build America c c Check to Check to Check to Check to Check to Check to Check to Check to Check to Check to Check to Health Insurance (1040 Line 29) 20 20 indicate indicate indicate indicate indicate indicate indicate indicate indicate indicate indicate Line 16A Line 16B Name of state(s) Canadian province or Otherwise enter amount from Form IN 111 Line 10 32 (1040 Line 28): (Add Lines 1 15) 16 16 (Full year Vermont residents enter zero (0) on Line 33) (See instructions) (See instructions) 34 *151131100* *151131200* 10 Partnerships/S Corporations 11 Rents royalties estates 12 Farm income or loss 12 12 13 Unemployment compensation 13 13 14 Taxable social security 14 14 15 Other: Specify 15 15 16 TOTAL INCOME 17 IRA (1040 Line 32; 1040A Line 17); Keogh/SEP/SIMPLE 18 Student Loan Interest (1040 Line 33; 1040A Line 18) 18 18 19 Employee Deductions: Reservists Performing Artists 20 Self Employment Deductions: Tax (1040 Line 27) and 21 Health Savings Account (1040 Line 25) 21 21 22 Moving Expenses (1040 Line 26) 22 22 23 Penalty on Early Withdrawal of Savings (1040 Line 30) 23 23 24 Alimony Paid (1040 Line 31a) 24 24 25 Domestic Production Activities (1040 Line 35) 25 25 26 Educator Expenses (1040 Line 23; 1040A Line 16) and 27 Deductions not listed above but included on 1040 Line 36 27 27 28 TOTAL ADJUSTMENTS (Add Lines 17 27) 28 28 29 Adjusted Gross Income (Subtract Line 28A from Line 16A) 29 30 Vermont Portion of AGI (Subtract Line 28B from Line 16B) 30 31 Non Vermont Income (Subtract Line 30 from Line 29) Also enter on Part II Line 33 below 31 32 Adjusted Gross Income If Part I completed enter Line 29 amount 33 Non Vermont Income (Line 31 above) 33 34 Military pay Number of months on active duty 35 Railroad Retirement income 35 36 Americans with Disabilities Credit 36 37 Bond/note interest income from 37 38 Total (Add Lines 33 37) 38 39 Vermont income (Subtract Line 38 from Line 32) 39 40 INCOME ADJUSTMENT % (Divide Line 39 by Line 32) Also enter on Form IN 111 Line 21 (See instructions) 40 A Federal Amount $ ADJUSTMENTS TO INCOME and LLCs 10 10 Authority B Vermont Portion $ Calculations Carried forward from Column B See instructions continued on back country during non Vermont residency Dates of Vermont residency in 2015 Fee basis Gov t Officials (1040 Line 24) 19 19 From (MM DD YYYY) To (MM DD YYYY) (use standard 2 character abbreviation) Full Year Residents with Adjustments Complete only Part II IN 113 INCOME Income Adjustment income taxes 4 4 Nonresidents and Part Year Residents Must Complete Parts I and II PART I Enter figures as they appear on your federal return or recomputed federal return in Column A and list the Vermont portion in PART II Adjustment for Vermont Exempt Income Part Year Residents: For Lines 34 37 enter only income included in Part I Line 30 Please PRINT in BLUE or BLACK INK ATTACH TO FORM IN 111 SCHEDULE Schedule IN 113 Schedule IN 113 page 2 of 2 Self 17 Spouse 17 17 Supply Authority Taxpayer s Last Name First Name Initial Taxpayer s Social Security Number Taxpayer s Last Name Social Security Number trusts etc 11 11 Tuition & Fees (1040 Line 34; 1040A Line 19) 26 26 VERMONT VERMONT EXEMPT INCOME Vermont Public Power Vermont Telecom