Form In-111 - Vermont Income Tax Return - 2015

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DUE DATE: April 18, 2016
Please PRINT in BLUE or BLACK INK
*151111100*
DEPT USE ONLY
2015
FORM
Income Tax Return
111
IN-
VERMONT
* 1 5 1 1 1 1 1 0 0 *
1
Taxpayer’s Last Name
First Name
Initial
Taxpayer’s Social Security Number
Spouse’s or CU Partner’s Last Name
First Name
Initial
Spouse’s or CU Partner’s Social Security Number
Mailing Address (Number and Street/Road or PO Box)
City
State
ZIP Code
Check here if using RECOMPUTED
Federal Return information
-
Check here if this is
Check if taxpayer
Check if Spouse or CU Partner
an AMENDED return
died during 2015
died during 2015
1. VT School District Code
2. 911 street address on 12/31/2015 - Number, street/road name (Do not use “PO Box”, “same”, or Town name)
2
FILING STATUS
Enter Spouse or
c
c
c
c
c
c
c
CU Partner full name ________________________________
8a. Married
8b. CU
3. Single
4. Head of
5. Married
6. CU Partner
7. Qualifying
Filing
Filing
Enter Spouse or CU Partner
Household
Filing
Filing
Widow(er) with
Separately
Separately
Social Security Number _______________________________
Jointly
Jointly
dependent children
9.
Exemptions Claimed (Federal Form 1040–Line 6d; 1040A–Line 6d; 1040EZ/1040NR-EZ–enter 0, 1, or 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. ______
3
Check to
.0 0
ç indicate
10. Adjusted Gross Income (Federal Form 1040–Line 37; 1040A–Line 21; 1040EZ–Line 4) . . . . . . .
10. _____________________________________
loss
Check to
11. Federal Taxable Income (Federal Form 1040–Line 43; 1040A–Line 27;
.0 0
ç indicate
11. _____________________________________
1040EZ–Line 6) If the Federal amount is zero, see instructions . . . . . . . . . . . . . . . . . . . . . .
loss
ADDITIONS:
.0 0
12a. Income from Non-Vermont State and Local Obligations (Schedule IN-112, Part I, Line 3) . . . . . . 12a. _____________________________________
.0 0
12b. Bonus Depreciation Allowed under Federal law for 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12b. _____________________________________
If negative
.0 0
ç check
12c. Addback of State and Local Income Taxes (Schedule IN-155, Line 8) . . . . . . . . . . .
12c. _____________________________________
here
.0 0
12d. Addback of Itemized Deductions (Schedule IN-155, Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12d. _____________________________________
Check to
.0 0
ç indicate
13. Federal Taxable Income with Additions (Add Lines 11, 12a, 12b, 12c, and 12d) . . . . . . . .
13. _____________________________________
loss
SUBTRACTIONS:
.0 0
14a. Interest Income from U.S. Obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a. _____________________________________
.0 0
14b. Capital Gains Exclusion (Schedule IN-153, Line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b. _____________________________________
.0 0
14c. Adjustment for Prior Years’ Bonus Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c. _____________________________________
.0 0
14d . Add Lines 14a, 14b, and 14c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d. _____________________________________
15. Vermont Taxable Income
.0 0
(Subtract Line 14d from Line 13 . If Line 14d is more than Line 13, enter zero .) . . . . . . . . . . . . . . . . . . . . . 15. _____________________________________
4
.0 0
16.
Vermont Income Tax from Tax Table or Tax Rate Schedule on Line 15 amount
. . . . . . . . . . . . . . . . . . 16. _____________________________________
(If Line 10 is greater than $150,000, see instructions)
.0 0
17. Additions to Vermont Income Tax (Schedule IN-112, Part II, Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. _____________________________________
.0 0
18. Vermont Income Tax with Additions (Add Lines 16 & 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. _____________________________________
.0 0
19. Subtractions from Vermont Income Tax (Schedule IN-112, Part II, Line 15) . . . . . . . . . . . . . . . . . . . . . . 19. _____________________________________
.0 0
20. Vermont Income Tax (Subtract Line 19 from Line 18 . If Line 19 is more than Line 18, enter zero) . . . . . 20. _____________________________________
.
%
21. Income Adjustment (Schedule IN-113, Line 40 OR 100 .00%)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. _____________________
.0 0
22. Adjusted Vermont Income Tax (Multiply Line 20 by Line 21)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. _____________________________________
5454
Continued on back
E
Form IN-111

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