Form In-116 - Vermont Income Tax Payment Voucher - 2013
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1Use this form if NOT submitting
*131161100*
payment with Form IN-111.
Income Tax
2013
FORM
* 1 3 1 1 6 1 1 0 0 *
116
IN-
Payment Voucher
VERMONT
Taxpayer’s Last Name
First Name
Initial
Taxpayer’s Social Security Number
Spouse or CU Partner Last Name
First Name
Initial
Spouse or CU Partner Social Security Number
Mailing Address (Number and Street/Roador PO Box)
City, Town
State
ZIP Code
-
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: VT Department of Taxes
PO Box 1779
Form IN-116
Montpelier, VT 05601-1779
(Rev. 09/13)
Make check payable to: VERMONT DEPARTMENT OF TAXES
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Important Printing Instructions
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