Form In-116 - Income Tax Payment Voucher
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1*061161199*
VT. DEPT. OF TAXES, PO Box 1779, Montpelier, VT 05601-1779
Income Tax
Form
2006
* 0 6 1 1 6 1 1 9 9 *
IN-116
Payment Voucher
VERMONT
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-
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Spouse or CU Partner
Taxpayer’s Social
Social Security Number
Security Number
Taxpayer’s Last Name
First Name
Initial
Spouse or CU Partner Last Name
First Name
Initial
Mailing Address (Number and Street/Road or PO Box)
City/Town
State
Zip Code
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.
,
,
Use this form if you are sending
0 0
Amount of this payment $
payment separate from Form IN-111
VERMONT DEPARTMENT OF TAXES
Make check payable to:
Form IN-116
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