Schedule K-1vt - Vermont Shareholder, Partner, Or Member Information

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Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
*14K1V1100*
Phone: (802) 828-5723
SHAREHOLDER, PARTNER, OR
VT Schedule
K-1VT
MEMBER INFORMATION
* 1 4 K 1 V 1 1 0 0 *
This schedule is REQUIRED.
For the taxable period beginning ________, 20____ and ending ________, 20____
Attach to Form BI-471
Month
Month
Business Name
Federal ID Number
HEADER INFORMATION - REQUIRED ENTRIES
Entity Name (Shareholder, Partner, or Member)
Federal ID Number
OR
OR
Individual Last Name (Shareholder, Partner, or Member)
First Name
MI
Social Security Number
Address
Recipient Type (I, C, S, L, P, X, or T)
Address, Line 2 (if needed)
Residency Status
c
VT Resident
City
State
ZIP Code
c
Nonresident
Foreign Country (if not United States)
%
Percentage of Entity’s income or loss to this recipient .
Calculate percentage to six places to the right of the decimal point .
c
c
Included with entity’s composite return? . . . . . . . . . . . . . . . . . . .
Yes
No
Place an “X” in the box left of the line number to indicate a loss amount.
Enter all amounts in whole dollars.
1. Vermont Business Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. __________________________________ .
2. Capital gains allocated to Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. __________________________________ .
3. Other income allocated to Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. __________________________________ .
4. Exempt Income - Vermont income not characterized as Unrelated Business
Income (UBI) for Federal purposes (tax-exempt entities only) . . . . . . . . . . . . . . . . . .4. __________________________________ .
5. Total annual nonresident estimated payments allocated to this shareholder . . . . . . . .5. __________________________________ .
6. Total annual real estate withholding payments allocated to this shareholder . . . . . . .6. __________________________________ .
7. Share of total federal bonus depreciation difference
(Enter on IN-111, Line 12b or Line 14c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. __________________________________ .
Schedule K-1VT
Rev. 10/15

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