Schedule K-1vt - Shareholder'S, Partner'S, Or Member'S Information - Vermont Department Of Taxes

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Vermont Department of Taxes
109 State Street
Montpelier, VT 05609-1401
(802) 828-5723
Shareholder’s, Partner’s, or Member’s Information
VERMONT
For tax year ending
Schedule
For Calendar Year 2003, or Fiscal Year
______
_______
K-1VT
year
month
Beginning ___________________ , Ending _______________________
This form is REQUIRED. Attach to VT Form BI-471
SHAREHOLDER / PARTNER / MEMBER NAME
SHAREHOLDER / PARTNER / MEMBER NO.
MAILING ADDRESS (STREET NUMBER OR PO BOX/STREET/SUITE OR ROOM NUMBER)
SOCIAL SECURITY NUMBER / FID NO. / EIN
CITY OR TOWN
STATE
ZIP CODE
RESIDENCY STATUS
c
c
Vermont Resident
Nonresident
ENTITY NAME
ENTITY IDENTIFYING NUMBER (FID NO. / EIN)
MAILING ADDRESS (STREET NUMBER OR PO BOX/STREET/SUITE OR ROOM NUMBER)
VERMONT BUSINESS ACCOUNT NUMBER
CITY OR TOWN
STATE
ZIP CODE
(#
#
#
#
#
#
X
X)
c
c
SHARE OF NET INCOME APPORTIONED TO VERMONT
TOTAL FISCAL YEAR REAL ESTATE WITHHOLDING
TOTAL FISCAL YEAR NONRESIDENT ESTIMATED PAYMENTS
1.
1. __________________________
2.
2. __________________________
3.
3. __________________________
4.
4. __________________________
5.
5. __________________________
6.
6. __________________________
7.
7. __________________________
8.
8. __________________________
9.
9. __________________________
10.
10. __________________________
11.
11. __________________________
12.
12. __________________________
13.
13. __________________________
14.
14. __________________________
15.
15. __________________________
16.
16. __________________________
17.
17. __________________________
Schedule K-1VT
1

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