Form Wht-434 - Vermont Annual Withholding Reconciliation

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Vermont Department of Taxes
PO Box 547 Montpelier, VT 05601-0547
*154341100*
Phone: (802) 828-2551, option #3
ANNUAL WITHHOLDING
VT Form
WHT-434
* 1 5 4 3 4 1 1 0 0 *
RECONCILIATION
Business Name
Federal ID Number
Address
Vermont Account ID
WHT-
Enter Reporting YEAR
City
State
ZIP Code
2015
Jan. 1 - Dec. 31,
Foreign Country
Due Date
2016
Last day of February,
For Department Use Only
Pay Frequency
c Semi-weekly
c Monthly
c Quarterly
c
Check here if your business has ceased and you would like your account closed . Cease date: ______ / ______ / ____________
A.
c
B.
Check here if you are reporting Third-Party Sick Pay .
. ____
C. Aggregate cost of applicable employer-sponsored health insurance coverage . . . . . . . . . . . . C. ______________________
PART I
VT W-2s
1. Number of W-2s submitted to Vermont . . . . . . 1. __________________________
2. Total Vermont wages paid per W-2s . . . . . . . . . 2. _____________________ . ____
3. Total Vermont tax withheld per W-2s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. ___________________ . ____
PART II
VT 1099s
4. Number of 1099s submitted to Vermont . . . . . 4. __________________________
5. Total nonwage payments reported on 1099s . . 5. _____________________ . ____
6. Total Vermont tax withheld per 1099s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. ___________________ . ____
PART III
RECONCILIATION
7. Total Vermont tax withheld (Add Lines 3 and 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7. ___________________ . ____
0.00
PART IV CERTIFICATION
I declare under the penalties of perjury, this return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the taxpayer,
his/her declaration further provides under 32 V.S.A. §§ 5901-5903 this information has not been and will not be used for any other purpose or made available to
any other person other than for the preparation of this return unless a separate valid consent form is signed by the taxpayer and retained by the preparer.
Signature of Officer or Authorized Agent
Date
Preparer’s Signature
Date
Title
Telephone Number
Firm’s name (or yours, if self-employed) and address
Check here if authorizing the VT Department of Taxes to
Preparer’s Telephone Number
Preparer’s PTIN or EIN
discuss this return and attachments with your preparer .
Form WHT-434
(formerly WH-434)
5454
Rev. 10/15
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