Schedule Ba-410 - Vermont Corporate Income Tax Affiliation Schedule Page 2

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*124101200*
Principal VT Corporation Name ________________________________________________________
Federal ID Number
* 1 2 4 1 0 1 2 0 0 *
Affiliate’s group type (Check ONE)
Federal ID Number
Water’s Edge
Excluded from VT Water’s
Excluded Qualified
Vermont
Check if
Combined
Edge Combined Group as
Overseas Business
Consolidated
Nexus
Group Member
nonunitary member
Organization
Group
in VT
Affiliate Name
Mailing Address, Line 1
Mailing Address, Line 2
City or Town
State
Zip Code
-
Affiliate’s group type (Check ONE)
Federal ID Number
Water’s Edge
Excluded from VT Water’s
Excluded Qualified
Vermont
Check if
Combined
Edge Combined Group as
Overseas Business
Consolidated
Nexus
Group Member
nonunitary member
Organization
Group
in VT
Affiliate Name
Mailing Address, Line 1
Mailing Address, Line 2
City or Town
State
Zip Code
Affiliate’s group type (Check ONE)
Federal ID Number
Water’s Edge
Excluded from VT Water’s
Excluded Qualified
Vermont
Check if
Combined
Edge Combined Group as
Overseas Business
Consolidated
Nexus
Group Member
nonunitary member
Organization
Group
in VT
Affiliate Name
Mailing Address, Line 1
Mailing Address, Line 2
City or Town
State
Zip Code
-
Schedule BA-410
Attach additional pages, if necessary
Rev. 10/12

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