VERMONT DEPARTMENT OF TAXES
*031511100*
PO Box 1779
Montpelier VT 05601-1779
(866) 828-2865
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VERMONT
2003
Application for Extension of Time to
File Vermont Individual Income Tax
2003
Complete this application if you are unable to file your
Vermont Income Tax Return before the due date of
April 15, 2004
.
An extension of time to file your return is not an extension of time to pay any tax due.
Taxpayers Social Security Number
Spouses or CU Partners Social Security Number
-
-
-
-
Taxpayers Last Name
First Name
Initial
Spouses or CU Partners Last Name
First Name
Initial
Mailing Address (Number and Street, including Rural Route)
City, Town, or Post Office
State
Zip Code
I request an automatic four-month extension of time to August 15,
2004
to file my
2003
Vermont Income Tax
Return.
I have already requested an automatic four-month extension of time to August 15,
2004
to file my
2003
Vermont
Income Tax Return, and am now requesting that an additional extension be granted to:
1 0
1
5
2
0
0
4
M
M
D
D
Y
Y
Y
Y
CALCULATION OF TAX DUE
,
,
.
2003
1. Estimated ________ individual income tax liability. . . . . . . . 1.
(year)
,
,
.
2. Previous payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
,
,
.
3. Amount of tax paid with this application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
Make check payable to VERMONT DEPARTMENT OF TAXES and mail it along with this application to the address at the top of this form.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct and complete. Preparers cannot use return information for purposes other than preparing returns.
Filing a fraudulent claim may result in penalties for the claimant or any person assisting in the preparation of such return.
Check here if authorizing the Director of Taxpayer Services or the Directors designee to discuss this return and attachments with your preparer.
TAXPAYERS SIGNATURE
DATE
SPOUSES OR CU PARTNERS SIGNATURE
DATE
Paid preparers use only.
PREPARERS SIGNATURE
DATE
PREPARERS EIN/SSN/PTIN
Preparers Telephone Number _____________________________________________________
Form IN-151