Vermont Form Bi-472 - S Corporation Schedule - 2005 Page 2
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2Vermont Business Account Number
# # # # # # X X
Business/Entity Name ____________________________________________________________________
(A)
(B)
(C)
(D)
(E)
(F)
Shareholder’s Name and Address
Social Security Number or
Individual
Shareholder’s Share of
Total Fiscal Year
Filing With
Federal I.D. Number
Percentage of
Line 9
Estimated Payments
Entity’s Compos-
Loss or Income
(Vermont Net Income)
(VT Form WH-435)
ite Return?
Yes / No
(Enter information from Columns D, E, and F on VT Schedule K-1VT)
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2. ____________________________
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3. ____________________________
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4. ____________________________
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5. ____________________________
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6. ____________________________
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7. ____________________________
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8. ____________________________
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9. ____________________________
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%
TOTALS
Attach additional sheets in the same format as necessary
Form BI-472
2
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