Vermont Department of Taxes
PO Box 1700 Montpelier, VT 05601-1700
*15K1F1100*
Phone: (802) 828-6820
BENEFICIARY INFORMATION
VT Schedule
K-1VT-F
* 1 5 K 1 F 1 1 0 0 *
for FIDUCIARIES
This schedule is REQUIRED.
For the taxable period beginning ________, 20____ and ending ________, 20____
Attach to Form FIT-161
Month
Month
Estate’s or Trust’s Name
Federal ID Number
HEADER INFORMATION - REQUIRED ENTRIES
Entity Name
Federal ID Number
OR
OR
Individual Last Name (Beneficiary)
First Name
MI
Social Security Number
Address
Recipient Type (I, C, S, L, P, X, or T)
Address, Line 2 (if needed)
Residency Status
VT Resident
Nonresident
City
State
ZIP Code
Check here if this is your
-
FINAL return
Foreign Country (if not United States)
%
Percentage of Estate’s or Trust’s income or loss to this recipient.
Calculate percentage to two places to the right of the decimal point.
Place an “X” in the box left of the line number to indicate a loss amount.
Enter all amounts in whole dollars.
1. Beneficiary’s Share of Federal Taxable Income . . . . . . . . . . . . . . . . . . . . . . . .
1. __________________________________ .
2. Interest / dividends from obligations of other states . . . . . . . . . . . . . . . . . . . . . . . . . .2. __________________________________ .
3. Interest / dividends from U.S. obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. __________________________________ .
4. Vermont Source Income for a Nonresident Beneficiary:
4a.
Interest income . . . . . . . . . . . . . . 4a. ______________________________ .
4b.
Dividend income . . . . . . . . . . . . 4b. ______________________________ .
4c.
Business income . . . . . . . . .
4c. ______________________________ .
4d.
4d. ______________________________ .
Capital gain or loss . . . . . . .
4e.
Partnership,
S corporation, LLC . . . . . . .
4e. ______________________________ .
4f.
Rent, royalties,
4f. ______________________________ .
estates, trusts . . . . . . . . . . .
4g.
Farm income . . . . . . . . . . . .
4g. ______________________________ .
4h.
Other income . . . . . . . . . . .
4h. ______________________________ .
4i. Total nonresident income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4i. __________________________________ .
5. Total annual nonresident estimated payments allocated to this beneficiary . . . . . . . .5. __________________________________ .
6. Total annual real estate withholding payments allocated to this beneficiary . . . . . . . .6. __________________________________ .
For Department Use Only
Schedule K-1VT-F
10/15
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