Vt Form In-116 - Income Tax Payment Voucher

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Use this form if NOT submitting
*151161100*
payment with Form IN-111.
VT Form
INCOME TAX PAYMENT VOUCHER
IN-116
* 1 5 1 1 6 1 1 0 0 *
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
Address
Tax Year (YYYY)
2015
City
State
ZIP Code
For Department Use Only
-
Foreign Country (if not United States)
If you electronically filed, DO NOT include a copy of the filed return with this payment.
5454
.0 0
Amount of this payment $ ______________________
Mail to: Vermont Department of Taxes
PO Box 1779
Form IN-116
Make check payable to: VERMONT DEPARTMENT OF TAXES
Montpelier, VT 05601-1779
(Rev. 11/15)
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