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             Vermont Department of Taxes 

                   Form BI-471                                                                                                                     *234711100*
    Vermont Business Income Tax Return                                                                                                             *234711100*
     for Partnerships, Subchapter S Corporations, and LLCs                                                                                                                                      Page 11

 Check             Name                        Composite                           Accounting                        Initial                         Public Law           Pro Forma -  
                   Change                      Return                              Period Change                     Return                          86-272 Applies       Cannabis
 Appropriate 
 Box(es)           Address                           Amended                               Extended                                      Federal                          Final Return
                   Change                            Return                                Return                                        Extension Requested              (Cancels Account)

                                   Entity Name                                                                                         FEIN                         Primary 6-digit NAICS number

                                     Address                                                                       Tax year BEGIN date (YYYYMMDD)                Tax year END date (YYYYMMDD)

                                 Address (Line 2)
                                                                                                                 Federal tax 
                   City                                          State               ZIP Code                    return filed 
                                                                                                                 (Check one                        1120S             1065             Other
                      Foreign Country (if not United States)                                                     box)

                                                                                                                                                                                                FORM  (Place at FIRST page)
 A.   Were any shareholders, partners, or members nonresidents of Vermont during this tax year?  . . . . . . . . . .                                       A.    Yes      No                    Form pages 

  B.  Did this entity have income or losses derived from at least one state other than Vermont?   . . . . . . . . . . . .  .  B.                                 Yes      No
      If Yes, complete and attach Schedule BI-477 .
 C.   Net adjustment to income resulting from Vermont’s disallowance of  
      “bonus depreciation” (IRC 168(k))  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   C.  ________________________ .00     11 - 12

 D.   Total number of Shareholders, Partners, or Members  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                D.  ____________________________

  E.  How many are Vermont Residents?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .E.  ____________________________

  F.  How many are Nonresidents?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .F.  ____________________________
 G.   Check box if 32 V .S .A . § 5920(f), (g), or (h) applies (regarding nonresident estimated payments for affordable housing projects, 
      federal new market tax credit projects, or publicly traded partnerships) . Attach authorization or documentation  . . . . . . . . . . . . . . . . . . . . G.

TAX COMPUTATION (see instructions):                                                                                              Enter all amounts in whole dollars.
 Check box if exception                                  NO VERMONT ACTIVITY /                                           INVESTMENT CLUB § 5921                           IRC § 761 
                                                         INACTIVE ($0)                                                   ($0)                                             ($0)
 to minimum tax applies:
  1.  Vermont minimum entity tax ($250) or above exception (See instructions)  . . . . . . . . . . . . . . . . . . . . . . . .  . 1.  ________________________ .00
  2.  For non-composite entities
         2a. Nonresident estimated payment requirement 
               (Schedule BI-472, Line 6)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 2a.  ________________________ .00
         2b. Overpayment distributed to owners (ADD Schedule K-1VT,  
               Lines 11 and 12  from all schedules, then SUBTRACT   
               amount from Schedule BI-472, Line 6)   . . . . . . . . . . . . . . . . .  . 2b.  ________________________ .00

 2c. ADD Lines 2a and 2b   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2c.  ________________________.00

 3.   For composite entities, Vermont composite tax due (Schedule BI-473, Line 11)  . . . . . . . . . . . . . . . . . . . .  . 3.  ________________________ .00

  4.  Vermont apportionment of entity level taxes (See instructions)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 4.  ________________________ .00

  5.  Use Tax for taxable items on which no sales tax was charged, including online purchases  . . . . . . . . . . . .  . 5.  ________________________ .00

  6.  Total tax due (ADD Lines 1, 2c, 3, 4, and 5)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 6.  ________________________ .00
                                                                                                                                                                     Form BI-471
5454                                                                                                                                                           Page 1 of 2, Rev. 10/23



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                                  Entity Name

              FEIN                           Fiscal Year Ending (YYYYMMDD)                             *234711200*
                                                                                                       *234711200*
                                                                                                                                                                                             Page 12
PAYMENTS AND CREDITS                                                                   Enter all amounts in whole dollars.

  7. Prior Year Overpayment Applied  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 7.  ________________________ .00

  8. Payments with Extension (Form BA-403)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 8.  ________________________ .00

  9.  Real estate withholding paid for this entity (Form REW-171, REW Schedule A)   . . . . . . . . . . . . . . . . . . .  . 9.  ________________________ .00

 10.  Real estate withholding distributed to this entity by a different company (Schedule K-1VT, Line 12)   . .  . 10.  ________________________ .00

 11.  Nonresident estimated payments paid by this entity (Form WH-435)  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 11.  ________________________ .00
 12.  Nonresident estimated payments distributed to this entity by a different company 
     (Schedule K-1VT, Line 11)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 12.  ________________________ .00

 13. Total payments (ADD Lines 7 through 12)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 13.  ________________________ .00
 RECONCILIATION                                                                                                                                                                              FORM  (Place at LAST page)
 14. Balance Due: If Line 6 is greater than Line 13, subtract Line 13 from Line 6 .  . . . . . . . . . . . . . . . . . . . . .  . 14.  ________________________ .00                          Form pages 

 15. Payment included with this return .  Make check payable to Vermont Department of Taxes.   . . . . . . . .  . 15.  ________________________ .00
 16. Overpayment: If Line 6 is less than the sum of Lines 13 and 15,  
     ADD Lines 13 and 15, then SUBTRACT Line 6.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 16.  ________________________ .00
                                                                                                                                                                                             11 - 12
 17.  Overpayment to be credited to the next tax year   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 17.  ________________________ .00

 18. Overpayment to be refunded  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 18.  ________________________ .00
SIGNATURE
I hereby certify that I am an officer or authorized agent responsible for the taxpayer’s compliance with the requirements of 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

                                                                                       /        /
 Printed Name                                Email Address (optional)

              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

                                                                                       /        /
 Preparer’s Printed Name                     Email Address (optional) 

 Firm’s Name (or yours if self-employed)                                   EIN                                                                              Preparer’s SSN or PTIN

 Firm’s Address (or yours if self-employed) (Street, City, State, ZIP Code)
                                                                                                                                                            Check if self-employed

     Send return                         Vermont Department of Taxes
     and check to:                       133 State Street                              For Department Use Only                                              Form BI-471
                                         Montpelier, VT  05633-1401          Ck. Amt.                  Init.                                                Page 2 of 2

5454                                                                                                                                                        Rev. 10/23






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