Vermont Department of Taxes 

                 Schedule K-1VT                                                                                                *23K1V1100*

      Vermont Shareholder, Partner, or                                                                                         *23K1V1100*
                                                                                                                                                                                   Page 7
                 Member Information                                                                                            This schedule is REQUIRED.
                                                                                                                                                      Include with Form BI-471

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

                                         HEADER INFORMATION - REQUIRED ENTRIES
                                Entity Name (Shareholder, Partner, or Member)                                                                                     FEIN

 OR   Individual Last Name (Shareholder, Partner, or Member)                     First Name                            Initial OR                      Social Security Number

                                                     Address                                                                   Recipient Type 
                                                                                                                               (I, C, S, L, P, X, or T)
                                         Address, Line 2 (if needed)                                                           Residency Status

                           City                                                 State         ZIP Code                                                 Vermont Resident            FORM  (Place at FIRST page)
                                                                                                                                                                                   Form pages 
                                         Foreign Country (if not United States)                                                                        Nonresident

PART I PASS-THROUGH ENTITY INFORMATION
 1.   Ownership percentage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 1.  _______ . ______________%     7 - 8

 2.   Profit  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. .          _______ . ______________%                               percentage 

 3.   Loss percentage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 3.  _______ . ______________%

 4.   Disregarded entity (single-member LLC or Qualified Subchapter S subsidiary)?                        . . . . . . . . . . .  . 4.                  Yes              No

 5.   Is this entity a unit of a Series LLC?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 5.        Yes              No

 6.   Did this entity pay tax on this income as part of a composite return?  . . . . . . . . . . . . . . . . . . . . .  . 6.                           Yes              No

PART II  DISTRIBUTIONS TO OWNERS                                                                                        Enter all amounts in whole dollars.

 7.   Vermont Business Income  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   . . . . . . . . . . . .  . 7.  ______________________.00

  8.  Capital gains allocated to Vermont  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 8.  ______________________.00

  9.  Other income allocated to Vermont   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 9.  ______________________.00
  10. Exempt Income - Vermont income not characterized as Unrelated 
      Business Income (UBI) for federal purposes (tax-exempt entities only)   . . . . . . . . . . . . . . . . .  . 10.  ______________________.00

  11.  Total annual nonresident estimated payments allocated to this shareholder  . . . . . . . . . . . . . . .  . 11.  ______________________.00

  12. Total annual real estate withholding payments allocated to this shareholder    . . . . . . . . . . . . .  . 12.  ______________________.00
  13. Share of total federal bonus depreciation difference.   
      Enter  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. .                                                        ______________________.00                               on Schedule IN-112, Line 4 or Line 9. 

  14.    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. .                                                                            ______________________.00                               Share of total state and local taxes deducted difference 

                                                             (continued on next page)                                                                  Schedule K-1VT
                                                                                                                                                              Page 1 of 2
5454                                                                                                                                                              Rev. 10/23

           Entity Name (same as on Form Form BI-471)

           FEIN                                                Fiscal Year Ending (YYYYMMDD)       *23K1V1200*
                                                                                                   *23K1V1200*
                                                                                                                                     Page 8

PART III  DISTRIBUTIVE SHARE OF APPORTIONMENT FACTORS
                                                               A.  Everywhere                      B.  Vermont

 15.  Sales  . . . . . . . . . . . . . . . . . . . . . . . .  .15A.  _________________________ .00 15B.  _________________________.00

 16.  Payroll   . . . . . . . . . . . . . . . . . . . . . .  .16A.  _________________________ .00  16B.  _________________________.00

 17.  Property  . . . . . . . . . . . . . . . . . . . . .  .17A.  _________________________ .00    17B.  _________________________.00

                                                                                                                                     FORM  (Place at LAST page)
                                                                                                                                     Form pages 

                                                                                                                                     7 - 8

                                                                                                   Schedule K-1VT
                                                                                                   Page 2 of 2
5454                                                                                               Rev. 10/23