Vermont Department of Taxes     PO Box 547    Montpelier, VT  05601-0547
Phone:  (802) 828-2551
      VT Form                                                                                         *204341100*
                      ANNUAL WITHHOLDING 
                                                                                                      *204341100*
WHT-434                           RECONCILIATION                                                                                                                                      Page 2

Business Name                                                                                   Federal ID Number

Address                                                                                         Vermont Account ID
                                                                                                WHT-
City                                                               State ZIP Code               Enter Reporting YEAR
                                                                                                   Jan. 1 - Dec. 31, 
Foreign Country                                                                                 Due Date
                                                                                                   Last day of January,
PayFor Department Use Only                                                                                                                                                                                       Frequency 
         c Semi-weekly                   c Monthly                       c Quarterly

A. c Check here if your business has ceased and you would like your account closed .    Cease date: ______ / ______ / ____________

B. c Check here if you are reporting Third-Party Sick Pay .                                                                                                                           FORM  (Place at FIRST page)
                                                                                                                                                                                      Form pages
C. Aggregate cost of applicable employer-sponsored health insurance coverage  . . . . . . . . . . . .    C.  ______________________                                   . ____

   PART I     VT W-2s
1. Number of W-2s submitted to Vermont  . . . . . . 1.   __________________________
                                                                                                                                                                                      2 - 2
2. Total Vermont wages paid per W-2s  . . . . . . . . . 2.   _____________________ . ____

3. Total Vermont tax withheld per W-2s  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .3.  ___________________ . ____

   PART II     VT 1099s
4. Number of 1099s submitted to Vermont   . . . . . 4.   __________________________

5. Total nonwage payments reported on 1099s   . . 5.   _____________________ . ____

6. Total Vermont tax withheld per 1099s  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .6.  ___________________ . ____

   PART III     RECONCILIATION
7. Total Vermont tax withheld (Add Lines 3 and 6)  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 7. . ___________________.  .  .  .  .  .  .  .  .        0.00. ____

PART IV CERTIFICATION
I declare under the penalties of perjury, this return is true, correct, and complete to the best of my knowledge.  If prepared by a person other than the taxpayer, 
his/her declaration further provides under 32 V.S.A. §§ 5901-5903 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.                           FORM  (Place at LAST page)
                                                                                                                                                                                      Form pages

Signature of Officer or Authorized Agent                 Date            Preparer’s Signature                                                           Date

Title                                    Telephone Number                Firm’s Name (or yours, if self-employed) and address
        Check here if authorizing the Vermont Department of Taxes        Preparer’sPreparer’s2 - 2                                                                                                               TelephonePTINNumberor EIN 
        to discuss this return and attachments with your preparer .

                                                                                                                                                        Form WHT-434
5454                                                                                                                                                    Rev. 12/20

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