Form IN-116 Fillable Income Tax Payment Voucher
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Montpelier VT 05601 1779 PO Box 1779 (Rev 11/15) *151161100* Address Tax Year (YYYY) Amount of this payment $ City State ZIP Code For Department Use Only Foreign Country (if not United States) Form IN 116 If you electronically filed DO NOT include a copy of the filed return with this payment IN 116 INCOME TAX PAYMENT VOUCHER Last Name First Name Initial Taxpayer s Social Security Number Mail to: Vermont Department of Taxes Make check payable to: VERMONT DEPARTMENT OF TAXES payment with Form IN 111 Spouse s or CU Partner s Last Name First Name Initial Spouse s or CU Partner s Social Security Number Use this form if NOT submitting VT Form