Form In-114 - Individual Income Estimated Tax Payment Vouchers

*081141100*

2011

VERMONT

Form IN-114

Individual Income Estimated

Use blue or black

* 0 8 1 1 4 1 1 0 0 *

Tax Payment Voucher

ink to write entries

Taxpayer’s Social Security Number

Spouse/CU Partner Social Security Number

Taxpayer’s Last Name

First Name

Initial

Spouse/CU Partner Last Name

First Name

Initial

Mailing Address (Number and Street, including Rural Route)

City, Town, or Post Office

State

Zip Code

Form IN-114

Amount of this payment $

. 0 0

Rev. 12/10

Mail voucher to:

Payment Due Dates

1st Quarter

APR 15, 2011

2nd Quarter

JUN 15, 2011

Vermont Department of Taxes

3rd Quarter

SEP 15, 2011

PO Box 1779

4th Quarter

JAN 15, 2012

Montpelier, VT

05601-1779

Taxpayer’s Worksheet

- Keep for your records

Line 1: Estimated 2011 Vermont taxable income: See definition on back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. $ _____________________________

Line 2: Estimated 2011 Vermont tax: Use 2011 preliminary tax schedules in this booklet . . . . . . . . . . . . . . . . . . . . . 2. $ _____________________________

Line 3: Estimated income adjustment: See instructions for Form IN-111, Line 21 in 2010 Vermont income tax booklet.* . . . . . . . . 3. ___________________ %

Line 4: Adjusted Vermont tax (Multiply Line 2 by Line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. $ _____________________________

4a. Less expected 2011 Vermont tax withholdings . . . . . . . . . . . . . . . . . . . . . . . . . 4a. $ ______________________

4b. Less expected credits: See 2010 Income tax return Form IN-111, Line 25 . . . . 4b. $ ______________________

4c. Total credits: Add Lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4c. $ _____________________________

Line 5: ESTIMATED TAX LIABILITY: Subtract Line 4c from Line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. $ _____________________________

*2010 Vermont income tax booklet is posted on our website at

RECORD of 2011 ESTIMATED PAYMENTS

TOTAL ESTIMATE

LESS 2010 INCOME TAX

AMOUNT OF

DATE PAID

BALANCE DUE

AMOUNT PAID

ORIGINAL OR AMENDED

REFUND APPLIED

INSTALLMENT DUE

_______________