Form In-111 - Vt Income Tax Return - 2001
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1
2*011111100*
Staple W-2/1099’s here
Income Tax Return
* 0 1 1 1 1 1 1 0 0 *
PRINT in BLUE or BLACK INK
1
-
-
PLACE LABEL HERE
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-
2
c
c
c
c
c
c
c
EXEMPTIONS CLAIMED
MUNICIPAL BOND INCOME
c
c
RECOMPUTED
ADJUSTED GROSS INCOME
0 0
.
,
,
ç
3
1. TAXABLE INCOME
0 0
.
,
,
1.
ç
0 0
.
,
,
2. VERMONT TAX
2.
.
3. INCOME ADJUSTMENT
3.
0 0
.
,
,
4. ADJUSTED TAX
4.
0 0
.
,
,
5. ALLOWABLE CREDITS
5.
0 0
.
,
,
6. TAX AFTER CREDITS
6.
0 0
.
,
,
7. ACT 60 PREBATE REPAYMENT
7.
0 0
.
,
8. USE TAX
8.
0 0
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,
,
9. TOTAL TAX DUE
4
10. VERMONT
CONTRIBUTIONS:
0 0
0 0
0 0
0 0
+
+
=
.
.
.
.
,
,
,
,
10.
0 0
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,
,
11. TOTAL TAX & CONTRIBUTIONS DUE
11.
5
0 0
.
,
,
12. VERMONT TAX WITHHELD
12.
0 0
.
,
,
13. OTHER PAYMENTS
13.
0 0
.
,
,
14. TOTAL PAYMENTS
14.
6
0 0
.
,
,
15. OVERPAYMENT
15.
0 0
.
,
,
16.
16.
0 0
.
,
,
17. REFUND
17.
0 0
.
,
,
18. BALANCE DUE
18.
Make check payable to Vermont Department of Taxes
Go To Section 9 To
* *
Sign Form
19. CHECK HERE IF PAYING LATE AND/OR UNDERPAYMENT OF ESTIMATED TAX CHARGES. INCLUDE FORM IN-152.
17
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