Form Bi-472 - S Corporation Schedule - Vermont - 1998 Page 3
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1
2
3Vermont Business Account Number
Business/Entity Name________________________________________________________
(B)
(C)
(D)
(E)
(F)
(A)
Filing With
Soc. Sec. Number or
Individual
Shareholder’s Share of Line 5
Total Fiscal Year
Shareholder’s Name and Address
Entity’s
Fed. I.D. Number
Percentage of Loss
(Vermont Net Income)
Estimated Payments
Composite
or Income
(Form WH-435)
Return?
Yes / No
1.__________________________
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2.__________________________
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__________________________
__________________________
3.__________________________
__________________________
__________________________
__________________________
4.__________________________
__________________________
__________________________
__________________________
5.__________________________
__________________________
__________________________
__________________________
6.__________________________
__________________________
__________________________
__________________________
7.__________________________
__________________________
__________________________
__________________________
8.__________________________
__________________________
__________________________
__________________________
9.__________________________
__________________________
__________________________
__________________________
TOTALS
%
Attach additional sheets in the same format as necessary
2
Form BI- 472
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