Form In-111 - Vermont Income Tax Return - 2012 Page 2
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1
2*121111299*
Keep a copy for your records.
Form IN-111, page 2 of 2
Enter amount from Line 22 ______________________________
* 1 2 1 1 1 1 2 9 9 *
5
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.
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0 0
0 0
0 0
+
=
23.
24.
25.
CREDIT FOR INCOME TAX PAID TO OTHER
VT TAX CREDITS (Schedule IN-112,
TOTAL VT CREDITS
STATE OR CANADIAN PROVINCE
Part IV, Line 7 OR Schedule IN-119)
(Add Lines 23 and 24)
(Schedule IN-117, Line 21)
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0 0
26.
VT INCOME TAX AFTER CREDITS (Subtract Line 25 from Line 22 . If Line 25 is more than Line 22, enter zero . ) . 26.
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0 0
27. USE TAX (See page 8 for instructions and chart) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.
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0 0
28. TOTAL VT TAXES (Add Lines 26 and 27) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28.
6
Nongame Wildlife Fund
Children’s Trust Fund
VT Veterans’ Fund
.
.
.
.
0 0
0 0
0 0
0 0
+
+
=
29a.
29b.
29c.
29d.
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0 0
30. TOTAL OF VT TAXES & VOLUNTARY CONTRIBUTIONS (Add Line 28 and Line 29d) . . . . . . . . . . . . . . 30.
7
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0 0
31a. From W-2, 1099, etc . VT Tax Withheld . . . . . . . . . . . . . . . . . .31a.
.
31b. From VT Form IN-114 Estimated Tax for 2012 and/or
0 0
Form IN-151, Extension with payment . . . . . . . . . . . . . . . . . 31b.
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0 0
31c. Earned Income Tax Credit (Schedule IN-112, Part III) . . . . . . . . . . . . . . . . . 31c.
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0 0
31d. Renter Rebate (Form PR-141, Line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31d.
.
31e. From VT Form RW-171 VT Real Estate Withholding (see
0 0
instructions on page 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31e.
31f. From VT Form WH-435 Estimated Income Tax Payment
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0 0
made by Business Entity for Nonresident Partner,
Member, or Shareholder (see page 9) . . . . . . . . . . . . . . . . . . . . . 31f.
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0 0
31g. Additional Refundable Credits
Documentation required (See instructions on page 9) . . . . . . . . . . . . . . . . . .31g.
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0 0
0 0
31h. TOTAL PAYMENTS AND CREDITS (Add Lines 31a through 31g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31h.
8
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0 0
0 0
32. OVERPAYMENT If Line 30 is less than Line 31h, subtract Line 30 from Line 31h . . . . . . . . . . . . . . . . . . . . . . 32.
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33a. REFUND TO BE CREDITED TO 2013 ESTIMATED TAX PAYMENT
0 0
Amount on 31d cannot be credited to 2013 estimated tax payment . . . . . . . 33a.
.
0 0
33b. REFUND TO BE CREDITED TO 2013 PROPERTY TAX BILL . 33b.
.
0 0
0 0
34. REFUND AMOUNT (Subtract Lines 33a and 33b from Line 32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34.
9
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0 0
0 0
35. If Line 30 is more than Line 31h, subtract Line 31h from Line 30 . See page 9 for instructions on tax due . . . . . . . . 35.
.
.
0 0
Interest and Penalty on Underpayment of
0 0
0 0
36.
37. Add Lines 35 and 36 37.
Estimated Tax (Worksheet IN-152 or 152A)
For amended
returns only
Original refund received ___________
Refund due now _______________
Original payment _____________
Amount due now ____________
10
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct and complete . Preparers cannot use return information for purposes other than preparing returns .
Check if age
Check if age
Signature
Signature
Date
Date
Occupation
Occupation
Telephone Number
Telephone Number
65 or older
65 or older
-
-
c
Signature. If a joint return, BOTH must sign.
Signature. If a joint return, BOTH must sign.
Date
Date
Occupation
Occupation
-
-
c
Check here if authorizing the VT Department of Taxes to discuss this return and attachments with your preparer.
Preparer’s signature
Date
Preparer’s
SSN or
Preparer’s
PTIN
Use Only
Firm’s name (or yours if self-employed) and address
EIN
Preparer’s Telephone Number
To claim refund, mail to:
With payment, mail to:
16
5454
Form IN-111
VT Department of Taxes, PO Box 1881, Montpelier, VT 05601-1881
VT Department of Taxes, PO Box 1779, Montpelier, VT 05601-1779
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