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Vermont Department of Taxes
Form BI-476 *234761100*
Vermont Business Income Tax Return *234761100*
Page 5
For Resident Only
Check Appropriate Name Address Accounting Extended Initial Return Pro Forma - Final Return
Box(es) X Change X Change X Period Change X Return X X Cannabis X (Cancels Account)
Entity Name (Principal Vermont Corporation) FEIN Primary 6-digit NAICS number
12345678901234567890123456789012(36) 123456789 123456
Address Tax year BEGIN date (YYYYMMDD) Tax year END date (YYYYMMDD)
12345678901234567890123456789012(36) 20230101 20231231
Address (Line 2) Federal tax return filed
12345678901234567890123456789012(36) (Check one box) X 1120S X 1065 X Other
City State ZIP Code Foreign Country
12345678901234567(21) 12 1234567890 1234567890123456789012345678(32)
A. Were any shareholders, partners, or members nonresidents of Vermont during this reporting tax year? . . . . . . . .A. X Yes X No
If Yes, STOP and complete Form BI-471, Business Income Tax Return .
B. Did this entity have income or losses derived from at least one state other than Vermont? . . . . . . . . . . . . . . . . . .B. X Yes X No
If Yes, STOP and complete Form BI-471, Business Income Tax Return .
123456 C. Total number of Vermont shareholders, partners, or members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C. ______________________ FORM (Place atFIRST page)
Form pages
TAX COMPUTATION (see instructions) Enter all amounts in whole dollars.
1. Vermont minimum entity tax ($250) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. ________________________250 .00
NOTE: If you qualify for an exception to the Vermont minimum entity tax, you must complete Form BI-471 and attach supporting documentation .
2. Payments previously made for this tax year with extension Form BA-403 or 5 - 5
123456789012345credit available through prior year carryforward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. ________________________.00
123456789012345 3. Balance Due (If Line 1 is greater than Line 2, Line 1 MINUS Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. ________________________.00
123456789012345 4. Overpayment (If Line 2 is greater than Line 1, Line 2 MINUS Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . ________________________.00
123456789012345 5. Overpayment to be Refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. . ________________________.00
123456789012345 6. Overpayment to be credited to next tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . ________________________.00
I hereby certify that I am an officer or authorized agent responsible for the taxpayer’s compliance with the requirements Vermont Statutes
Annotated, Title 32, and that this return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the
taxpayer, this declaration further provides that under 32 V.S.A. § 5901, this information has not been and will not be used for any other purpose,
or made available to any other person, other than for the preparation of this return unless a separate valid consent form is signed by the taxpayer
and retained by the preparer.
Signature of Responsible Officer Date (MM/DD/YYYY) Daytime Telephone Number
12 / 31 / 2023 802-123-1234
Printed Name Email Address (optional)
12345678901234567890123 1234567890123456789012345678901234567890123456
X Check if the Vermont Department of Taxes may discuss this return with the preparer shown.
Signature of Paid Preparer Date (MM/DD/YYYY) Preparer’s Telephone Number
12 / 31 / 2023 802-123-1234
Preparer’s Printed Name Email Address (optional)
12345678901234567890123 1234567890123456789012345678901234567890123456 FORM (Place at LAST page)
Firm’s Name (or yours if self-employed) EIN Preparer’s SSN or PTIN Form pages
1234567980123456789012345678901234567890 123456789 123456789
Firm’s Address (or yours if self-employed) (Street, City, State, ZIP Code)
12345678901234567890123456789012345678901234567890123456 X Check if self-employed
Send return Vermont Department of Taxes For Department Use Only Form BI-476
and check to: 133 State Street Ck. Amt. Init. Page 1 of 1 5 - 5
Montpelier, VT 05633-1401 Rev. 10/23