Form In-111 - Vermont Income Tax Return - 2012

DUE DATE: April 15, 2013

Please PRINT in BLUE or BLACK INK

*121111199*

DEPT USE ONLY

2012

FORM

Income Tax Return

111

IN-

* 1 2 1 1 1 1 1 9 9 *

VERMONT

Check here if using

If filing jointly,

-

-

1

-

-

RECOMPUTED Federal

c

Taxpayer’s Social

Spouse or CU Partner

Return information

Security Number

Social Security Number

Taxpayer’s

First

Initial

Last Name

Name

Spouse or

First

CU Partner

Initial

Name

Last Name

Mailing Address

(Number and Street/

Road or PO Box)

-

ZIP

City/Town

State

Code

Check here

Check if

Check if Spouse

1. VT School Code

2. 911 street address on 12/31/2012

if this is an

taxpayer

or CU Partner

AMENDED

died during

died during

return

2012

2012

Number, street / road name (Do not use “PO Box”, “same”, or Town name)

2

FILING STATUS

8a

8b

c

c

3

4

5

6

7

c

c

c

c

c

Enter Spouse or CU Partner full name

Married

CU

Enter Spouse or

Enter Spouse or

Single

Head of

Married

CU Partner

Qualifying

-

-

Filing

Filing

CU Partner Social

CU Partner Social

Household

Filing

Filing

Widow(er) with

Separately

Separately

Security Number

Security Number

Jointly

Jointly

dependent children

9.

EXEMPTIONS CLAIMED (Federal Form 1040–Line 6d; 1040A–Line 6d; 1040EZ/1040NR-EZ–enter 0, 1, or 2) . . . . . . . . . . . . . . . . . . . . . . . . . 9.

3

Check to

.

ç indicate

0 0

loss

10. ADJUSTED GROSS INCOME (Federal Form 1040–Line 37; 1040A–Line 21; 1040EZ–Line 4)

10.

Check to

.

11. FEDERAL TAXABLE INCOME (Federal Form 1040–Line 43; 1040A–Line 27;

ç indicate

0 0

loss

1040EZ–Line 6) If the Federal amount is zero, see instructions on page 6 . . . . . . . . . . . . . .

11.

.

ADDITIONS:

0 0

12a. Income from Non-VT State and Local Obligations (Schedule IN-112, Part I, Line 3) . . . . . . . . . . . . . . . . 12a.

.

0 0

12b. Bonus Depreciation allowed under Federal law for 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12b.

If negative

.

0 0

ç check

12c. Addback of State and Local Income Taxes (Schedule IN-154, Line 10) . . . . . . . . . . . . . .

12c.

here

Check to

.

ç indicate

0 0

loss

13. FEDERAL TAXABLE INCOME WITH ADDITIONS (Add Lines 11, 12a, 12b, and 12c) . . .

13.

.

SUBTRACTIONS:

0 0

14a. Interest Income from U.S. Obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a.

.

0 0

14b. Capital Gains Exclusion (From Schedule IN-153, Line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14b.

.

0 0

14c. Adjustment for prior years’ Bonus Depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14c.

.

0 0

14d . Add Lines 14a, 14b, and 14c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14d.

.

15. VT TAXABLE INCOME

0 0

(Subtract Line 14d from Line 13 . If Line 14d is more than Line 13, enter zero .) . . . . . . . . . . . . . . . . . . . . . 15.

4

.

0 0

16. VT INCOME TAX FROM VT TAX TABLE OR TAX RATE SCHEDULE on Line 15 amount . . . . . 16.

.

0 0

17. ADDITIONS TO VT INCOME TAX (Schedule IN-112, Part II, Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . 17.

.

0 0

18. VT INCOME TAX WITH ADDITIONS (Add Lines 16 & 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18.

.

0 0

19. SUBTRACTIONS FROM VT INCOME TAX (Schedule IN-112, Part II, Line 15) . . . . . . . . . . . . . . . . . 19.

.

0 0

20. VT INCOME TAX (Subtract Line 19 from Line 18) If Line 19 is more than Line 18, enter zero . . . . . . . 20.

%

.

21. INCOME ADJUSTMENT (Schedule IN-113, Line 43 OR 100 .00%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.

.

0 0

22. ADJUSTED VT INCOME TAX (Multiply Line 20 by Line 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 .

15

Continued on back

*

Form IN-111