Income Tax Payment Voucher Template - 2001
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1VT. DEPT. OF TAXES, PO Box 1779, Montpelier, VT 05601-1779
Income Tax
2001
* 0 1 1 1 6 1 1 0 0 *
Payment Voucher
Vermont
Taxpayer’s Social Security Number
Check for name or
Taxpayer’s Last Name
First Name
Initial
address change
-
-
Spouse or CU Partner Last Name
First Name
Initial
Spouse or CU Partner Social Security Number
-
-
Mailing Address (Number and Street, including Rural Route)
City, Town, or Post Office
State
Zip Code
.
,
,
Make check payable to:
Amount of this payment $
VERMONT DEPARTMENT OF TAXES
Form IN-116
Cut on dotted line and mail top portion with Form IN-111 and check or money order to:
Vermont Department of Taxes
PO Box 1779
Montpelier, VT 05601-1779
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