Vermont Department of Taxes 

                 Schedule BI-472                                                                                                    *234721100*

            Vermont Non-Composite                                                                                                   *234721100*
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PRINT in BLUE or BLACK INK                                                                                                                   Include with Form BI-471

                   Entity Name (same as on Form BI-471)                                             Fiscal Year Ending (YYYYMMDD)                                                                                  FEIN
  12345678901234567890123456789012(36)       20231231        123456789

                                                                                                                                              Enter all amounts in whole dollars.

                                                         123456789012345  1. Income Attributable to Vermont (Schedule BI-477, Line 28)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .1.  ________________________.00

                                                         123456789012345  2. Other adjustments to income attributable to Vermont  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .2.  ________________________.00

                                                         123456789012345  3. Total Income Attributable to Vermont(ADD Lines 1 and 2)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . ________________________.00

                                                              4. Percentage of income from Line 3 passed through to nonresidents  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . __________100.000000______________%

                                                         123456789012345  5. Total income passed through to nonresidents(MULTIPLY Line 3 by Line 4)  . . . . . . . . . . . . . . . . . . . . . 5. . ________________________.00
                                                                                                                                                                                                                                                     FORM  (Place at FIRST page)
                                                         123456789012345                             6. Nonresident estimated payment requirement(MULTIPLY Line 5 by 6.6% (0.066))  . . . . . . . . . . . . . . . . 6. . ________________________.00 Form pages 

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                                                                                                                                                                                                                                                     FORM  (Place at LAST page)
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                                                                                                                                                  Schedule BI-472
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5454                                                                                                                                                                                                 Rev. 10/23