Form In-111 - Vermont Income Tax Return - 2004
ADVERTISEMENT
1
2*041111199*
DUE DATE: April 15, 2005
PRINT in BLUE or BLACK INK
2004
FORM
Income Tax Return
IN-111
VERMONT
* 0 4 1 1 1 1 1 9 9 *
CHECK HERE if Fiscal Year Filer from ______________ to ______________
-
-
-
-
Spouse or CU Partner
Taxpayer’s Social
1
Social Security Number
Security Number
Taxpayer’s Last Name
First Name
Initial
Spouse or CU Partner Last Name
First Name
Initial
PLACE LABEL HERE
Mailing Address (Number and Street/Road or PO Box)
City/Town
State
Zip Code
-
1
VT School
District Code
2
City/Town of Legal Residence on 12/31/2004
State
Check here if this is an
Check if Spouse or CU
Check if taxpayer died
AMENDED return
Partner died during 2004
during 2004
TAX FILING INFORMATION
2
3
4
5
6
7a
7b
8
FILING
Single
Head of
Married
CU Partner
Married
CU Partner
Qualifying Widow(er)
Enter Spouse or CU Partner full name here.
STATUS
Household
Filing
Filing
Filing
Filing
with dependent
Enter social security number above.
Jointly
Jointly
Separately
Separately
children
9. EXEMPTIONS CLAIMED (From Federal Form 1040–Line 6d; 1040A–Line 6d; 1040EZ/1040NR-EZ/Telefile–enter 0, 1, or 2; 1040NR-Line 7d) . . . . . . . . . 9.
Check to
10. ADJUSTED GROSS INCOME (From Federal Form 1040–Line 36; 1040A–Line 21;
.
,
,
indicate loss
0 0
1040EZ–Line 4; Telefile–Line I; 1040NR-Line 34; 1040NR-EZ-Line 10). . . . . . . . . . . . . . . . . . .
10.
TAXABLE INCOME
3
11. FEDERAL TAXABLE INCOME If the Federal amount is zero, see instructions on page 7.
Check to
(From Federal Form 1040–Line 42; 1040A–Line 27; 1040EZ–Line 6; Telefile–Line K(1);
.
,
,
0 0
indicate loss
1040NR-Line 39; 1040NR-EZ-Line 14). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
12. ADDITIONS TO FEDERAL TAXABLE INCOME
.
,
,
0 0
Income from Non-VT State and Local Obligations (from Form IN-112, VT Schedule A, Part I, Line 3) . . . . . . . . . 12.
Check to
.
,
,
0 0
indicate loss
13. FEDERAL TAXABLE INCOME WITH ADDITIONS (Add Lines 11 and 12). . . . . . . . . . . . . . . .
13.
14. SUBTRACTIONS FROM FEDERAL TAXABLE INCOME
.
,
,
0 0
14a. Interest Income from U.S. Obligations. . . . . . . . . . . . . . . . 14a.
.
.
,
,
,
,
0 0
0 0
x 40%
14b.
14c.
Capital Gains (from Form IN-112, Capital Gains Worksheet, Line M)
14d. Angel Venture Capital Gain Deferral
.
,
,
0 0
(see instructions on page 8). . . . . . . . . . . . . . . . . . . . . . . . . . 14d.
.
,
,
0 0
14e. TOTAL SUBTRACTIONS (Add Lines 14a, 14c, and 14d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e.
Check to
.
,
,
indicate loss
0 0
15. VT TAXABLE INCOME (Subtract Line 14e from Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15.
VT INCOME TAX
4
.
,
,
0 0
16. VT INCOME TAX FROM VT TAX TABLE OR TAX RATE SCHEDULE on Line 15 amount . . . . . . . . . . . . . . . . . . . 16.
.
,
,
0 0
17. ADDITIONS TO VT INCOME TAX (from Form IN-112, VT Schedule A, Part II, Line 8) . . . . . . . . . . . . . . . . . . . . . . . 17.
.
,
,
0 0
18. VT INCOME TAX WITH ADDITIONS (Add Lines 16 & 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.
.
,
,
0 0
19. SUBTRACTIONS FROM VT INCOME TAX (from Form IN-112, VT Schedule A, Part II, Line 14) . . . . . . . . . . . . . . . 19.
.
,
,
0 0
20. VT INCOME TAX (Subtract Line 19 from Line 18) but cannot be less than zero. . . . . . . . . . . . . . . . . . . . . . . . . . . 20.
.
%
21. INCOME ADJUSTMENT (from Form IN-113, Line 40 OR 100.00%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.
.
,
,
0 0
22. ADJUSTED VT INCOME TAX (Multiply Line 20 by Line 21). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.
13
Form IN-111
Continued on back
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial