Vt Form Bi-471 - Business Income Tax Return Page 2

Entity Name

*164711200*

Federal ID Number

Fiscal Year Ending (YYYYMMDD)

* 1 6 4 7 1 1 2 0 0 *

Amount from Line 5 _____________________________

PAYMENTS AND CREDITS

Enter all amounts in whole dollars.

6. Prior Year Overpayment Applied . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. ___________________________________.

7. Payments with Extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7. ___________________________________.

8. Real estate withholding paid for this entity with Form RW-171,

REW Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8. ___________________________________.

9. Real estate withholding distributed to this entity by a different company

through a Schedule K-1VT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9. ___________________________________.

10. Nonresident estimated payments paid by this entity with Form WH-435 . . . . . . . . .10. ___________________________________.

11. Nonresident estimated payments distributed to this entity by a different

company through a Schedule K-1VT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. ___________________________________.

12. Total payments (Add Lines 6-11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12. ___________________________________.

RECONCILIATION

Enter all amounts in whole dollars.

13. Balance due: If Line 5 is greater than Line 12, enter the difference . . . . . . . . . . . .13. ___________________________________.

14. Payment attached to this return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14. ___________________________________.

15. Overpayment: If Line 5 is less than the sum of Lines 12 and 14,

enter the difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15. ___________________________________.

16. For non-composite entities only: Overpayment distributed to owners via

Schedule K-1VT (NOTE: Overpayments generated by real estate withholding

payments must be distributed to owners) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16. ___________________________________.

17. Overpayment to be credited to next tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . .17. ___________________________________.

18. Overpayment to be refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18. ___________________________________.

I hereby certify that I am an officer or authorized agent responsible for the taxpayer’s compliance with the requirements of Title 32 of the Vermont Statutes and that this

return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the taxpayer, this declaration further provides that under 32 V.S.A.

§ 5901, this information has not been and will not be used for any other purpose, or made available to any other person, other than for the preparation of this return

unless a separate valid consent form is signed by the taxpayer and retained by the preparer.

Signature of Officer or Authorized Agent

Date

Daytime telephone

May the Dept. of Taxes discuss this

number (optional)

return with the preparer shown?

(

)

 Yes

 No

Printed name

E-mail address (optional)

Date

Preparer’s



Check if self-employed

signature

Paid

Preparer’s

Preparer’s Social

Security No. or PTIN

printed name

Preparer’s

Firm’s name (or yours if self-employed) and address

Use Only

EIN

Preparer’s Telephone Number

Preparer’s e-mail address (optional)

(

)

Form BI-471

5454

Rev. 10/16