Vt Schedule Oic-672 - Collection Information Statement For Businesses
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6Vermont Department of Taxes
PO Box 429
Montpelier, VT 05601-0429
*176721100*
Phone: (802) 828-2518
COLLECTION INFORMATION
VT Schedule
* 1 7 6 7 2 1 1 0 0 *
OIC-672
STATEMENT FOR BUSINESSES
Attach to Form OIC-671
Complete this form if your business is a Corporation, Partnership, Limited Liability Company (LLC) classified as a corporation,
other multi-owner/multi-member LLC, single member LLC. If your business is a sole proprietorship (filing Schedule C), do
not use this form. Instead, complete Form OIC-673, Collection Information Statement for Wage Earners and Self-Employed
Individuals.
Include attachments if additional space is needed to respond completely to any question.
SECTION 1
BUSINESS INFORMATION
Business Name
Employer Identification Number
Trade Name or d/b/a
Description of Business
Mailing Address
County of Business Location
City
State
ZIP Code
Primary Telephone Number
Foreign Country (if not United States)
Business Website Address
Email Address
State Contractor?
Total Number of Employees
Frequency of Tax Deposits
Average Gross Monthly Payroll
Yes
No
Does the business use a
If yes, enter Provider’s Name
Mailing Address of Provider
payroll service provider?
City
State
ZIP Code
Yes
No
Provide information about all partners, officers, LLC members, major shareholders (foreign and domestic), etc., associated
with the business.
Partner, Officer, LLC Member, Major Shareholder, etc. #1
Last Name
First Name
Initial
Social Security Number
Home Mailing Address
Title
City
State
ZIP Code
Primary Telephone Number
Foreign Country (if not United States)
Percent of Ownership
Secondary Telephone Number
%
Partner, Officer, LLC Member, Major Shareholder, etc. #2
Last Name
First Name
Initial
Social Security Number
Home Mailing Address
Title
City
State
ZIP Code
Primary Telephone Number
Foreign Country (if not United States)
Percent of Ownership
Secondary Telephone Number
%
Schedule OIC-672
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