Vt Form Bi-476 - Business Income Tax Return

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Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
*164761100*
Phone: (802) 828-5723
BUSINESS INCOME TAX RETURN
VT Form
BI-476
* 1 6 4 7 6 1 1 0 0 *
For Resident Only
For Partnerships, Subchapter S Corporations, and LLCs
Entity Name
Check
ACCOUNTING
INITIAL RETURN
PERIOD CHANGE
appropriate
EXTENDED
FINAL RETURN
box(es)
RETURN
(CANCELS ACCOUNT)
Address
Federal ID Number
Tax year BEGIN date (YYYYMMDD)
Tax year END date (YYYYMMDD)
City
State
ZIP Code
Entity’s Primary 6-digit NAICS number
Foreign Country (if not United States)
Federal tax return filed (check one box)
1120S
1065
Other ______________
A. Were any shareholders, partners, or members nonresidents of Vermont during this reporting tax year? . . . . . .
Yes
No
If Yes, STOP and complete Form BI-471.
B. Did this entity have income or losses derived from at least one state other than VT? . . . . . . . . . . . . . . . . . . . .
Yes
No
If Yes, STOP and complete Form BI-471.
C. Total number of Vermont shareholders, partners, or members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C . _______________
TAX COMPUTATION (see instructions)
Enter all amounts in whole dollars.
250
1. Vermont minimum entity tax ($250) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. ______________ .
NOTE: If you qualify for an exception to the Vermont minimum entity tax, you must complete
Form BI-471 and attach supporting documentation .
2. Payments previously made for this tax year with extension Form BA-403 or
credit available through prior year carryforward . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. __________________________________ .
3. Balance Due (If Line 1 is greater than Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. __________________________________ .
4. Overpayment (If Line 2 is greater than Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4. __________________________________ .
5. Overpayment to be Refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5. __________________________________ .
6. Overpayment to be credited to next tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. __________________________________ .
I hereby certify that I am an officer or authorized agent responsible for the taxpayer’s compliance with the requirements of Title 32 of the Vermont Statutes and that this
return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the taxpayer, this declaration further provides that under 32 V.S.A.
§ 5901, this information has not been and will not be used for any other purpose, or made available to any other person, other than for the preparation of this return
unless a separate valid consent form is signed by the taxpayer and retained by the preparer.
Signature of Officer or Authorized Agent
Date
Daytime telephone
May the Dept. of Taxes discuss this
number (optional)
return with the preparer shown?
(
)
 Yes
 No
Printed name
E-mail address (optional)
Date
Preparer’s
Check if self-employed
signature
Paid
Preparer’s
Preparer’s Social
printed name
Security No. or PTIN
Preparer’s
Firm’s name (or yours if self-employed) and address
Use Only
EIN
Preparer’s Telephone Number
Preparer’s e-mail address (optional)
(
)
Form BI-476
5454
Rev. 10/16

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