Page 2
Keep a copy for
your records.
Form IN-111
Rev. 10/19Page 2 of 2
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.
Other State Credit (Schedule IN-117, Line 21) Vermont Tax Credits (Schedule IN-119, Part II) Total Vermont Credits (Add Lines 17 and 18)
OR
Check to certify
no Use Tax is due.
Taxpayer’s Last Name Social Security Number
Check if the Department of Taxes may discuss this return with the preparer shown.
For Amended
Returns Only:
Original refund received Refund due now Original payment Amount due now
.00 .00 .00.00
Signature Date Date of Birth (MM/DD/YYYY) Daytime Telephone Number
Signature (If a joint return, BOTH must sign.) Date Date of Birth (MM/DD/YYYY) Daytime Telephone Number
Paid Preparer’s Signature Date Preparer’s Telephone Number
Firm’s Name (or yours if self-employed) and address Preparer’s SSN or PTIN EIN
/ /
/ /
Green Up Vermont Total ContributionsVermont Veterans FundChildren’s Trust FundNongame Wildlife Fund
5432
17. _____________________ .00 + 18. ____________________ .00 = 19. __________________________ .00
20. Vermont Income Tax after credits (Subtract Line 19 from Line 16.
If Line 19 is greater than Line 16, enter -0-)
..............................................20. __________________________ .00
21. Use Tax for taxable items on which no sales tax was charged,
including online purchases. (See instructions, worksheet, and chart) ... 21. __________________________ .00
22. Total Vermont Taxes (Add Lines 20 and 21) .............................................22. __________________________ .00
23a. _________.00 + 23b. _________.00 + 23c. _________.00 + 23d. _________.00 = 23e. ___________ .00
24. Total of Vermont Taxes and Voluntary Contributions (Add Lines 22 and 23e) ...................24. __________________________ .00
25a. 2019 Vermont Tax Withheld from W-2, 1099 ................... 25a. __________________ .00
25b. 2019 Estimated Tax payments, amount carried forward from 2018,
and payment made with 2019 extension
........................ 25b. __________________ .00
25c. Refundable Credits (Schedule IN-112, Part II) ....................25c. __________________ .00
25d. 2019 Vermont Real Estate Withholding from Form RW-171 .......25d. __________________ .00
25e. 2019 Nonresident Estimated Tax payments
(nonresident withholding) allocated on Schedule K-1VT, Line 5
.....25e. __________________ .00
25f. Total Payments and Credits (Add Lines 25a through 25e) .................................. 25f. __________________________ .00
26. Overpayment. If Line 24 is less than Line 25f, Subtract Line 24 from Line 25f ..................26. __________________________ .00
27a. Refund to be credited to 2020 Estimated Tax Payment ............ 27a. __________________ .00
27b. Refund to be credited to 2020 Property Tax Bill ................. 27b. __________________ .00
28. REFUND AMOUNT (Subtract Lines 27a and 27b from Line 26) ............................28. __________________________ .00
29. If Line 24 is more than Line 25f, Subtract Line 25f from Line 24.
See instructions on tax due
...........................................................29. __________________________ .00
30. Interest and Penalty on 31. AMOUNT DUE
Underpayment of Estimated Tax ..30. _________________.00 (Add Lines 29 and 30) . 31. __________________________ .00
(Worksheet IN-152 or IN-152A)
*1911112WW*
*1911112WW*
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