Form 8879-Vt - Individual Income Tax Declaration For Electronic Filing

VERMONT

2007

For office use only

Date received

Individual Income Tax Declaration for Electronic Filing

Form 8879-VT

(SEE INSTRUCTIONS IN THE VT FED/STATE E-FILE HANDBOOK)

Last Name

First Name and Initial

Enter Social Security Number (SSN)

Part I

Spouse’s Last Name (if different and joint return)

First Name and Initial

Enter Spouse’s SSN, if joint return

Remember

to write in

Current Mailing Address

e-mail address

your Social

Security

Number

City or Town

State

Zip Code

Telephone Number

(

)

Part II Tax Return Information (whole dollars only)

1. Federal Taxable Income (Form IN-111, Section 3, Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. _____________________

2. Vermont Taxable Income (Form IN-111, Section 3, Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. _____________________

3. Adjusted VT Income Tax (Form IN-111, Section 4, Line 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. _____________________

4. Vermont income tax withheld (Form IN-111, Section 7, Line 31a) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. _____________________

5. Vermont Earned Income Tax Credit (Form IN-111, Section 7, Line 31c) . . . . . . . . . . . . . . . . . . . . . . 5. _____________________

6. Overpayment credited to 2008 estimated tax (Form IN-111, Section 8, Line 33a) . . . . . . . . . . . . . . . 6. _____________________

7. Overpayment credited to 2008 property tax bill (Form IN-111, Section 8, Line 33b) . . . . . . . . . . . . . 7. _____________________

Refund (Form IN-111, Section 8, Line 34)

(check applicable box)

Amount Due (Form IN-111, Section 9, Line 37) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. _____________________

DO NOT MAIL THIS FORM

-- KEEP THIS FORM AND REQUIRED ATTACHMENTS ON FILE FOR 3 YEARS

Part III Form HS-122 For Vermont Residents Only (check one box)

Declaration of VT Homestead form only

Declaration of VT Homestead & Property Tax Adjustment application

Part IV

Direct Deposit of Refund

ACH Debit Payment Amount $____________ Payment Date ____/____/2008

Routing transit number (RTN)

The first two numbers of the RTN must be 01 through 12 or 21 through 32.

Depositor account number (DAN)

Type of account:

Savings

Checking

Part V Declaration of Taxpayer

By signing below, you agree that:

•

Under penalties of perjury, I declare the information I provided to my Electronic Return Originator (ERO) and the amounts shown in Part II agree

with the amounts shown on the corresponding lines of my 2007 Vermont Individual Income tax return and is, to the best of my knowledge and

belief, true, accurate and complete.

•

If making an ACH Debit Payment, I authorize the Deparment to withdraw funds from my account in the amount and on the date specified.

•

I consent to have the ERO forward my return, including this declaration and accompanying schedules and statements, to the Vermont Department

of Taxes upon the Department’s request.

•

If the Vermont Department of Taxes does not receive full and timely payment of the amount due, I am liable for the tax and any applicable charges.

•

I authorize the Department to disclose to the ERO the reason my refund is delayed and to confirm to the ERO the date my refund is sent.

Please

Sign Here

Your Signature

Date

Spouse’s Signature (if joint return, BOTH must sign)

Date

Part VI Declaration of Electronic Return Originator (ERO) Only

As an ERO, I am not responsible for review of the taxpayer’s return but declare this form accurately reflects the data on the return. The taxpayer(s)

signed this form before I submitted the return. I will give the taxpayer a copy of all forms and information to be filed with Vermont.

ERO’s

Date

Check if:

paid preparer

Electronic

self-employed

signature

Return

Firm’s name (or

Originator’s

EIN

yours if self-

Use Only

employed) and

Phone Number

address

e-mail address:

Part VII Declaration of Paid Preparer

Under penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statement. To the best of my

knowledge and belief, they are true, correct and complete. This declaration is based on all information of which I have knowledge.

Date

Check if

Preparer’s

self-employed

Paid

signature

Preparer’s

Firm’s name (or

Use Only

EIN

yours if self-

employed) and

Phone Number

address

e-mail address:

Form 8879-Vt - Individual Income Tax Declaration For Electronic Filing - 2007

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