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Vermont Department of Taxes
Schedule CO-420 *234201100*
Vermont Foreign Dividend Factor Increments *234201100*
Page 3
(for Unitary Filers only)
Complete for each dividend payor affiliate. More than one Schedule CO-420 may be attached. Include with Form CO-411
Enter all amounts in WHOLE DOLLARS.
Entity Name (same as on Form CO-411) Fiscal Year Ending (YYYYMMDD) FEIN
12345678901234567890123456789012(36) 20231231 123456789
Name of Affiliate Affiliate’s FEIN
Affiliate #1
12345678901234567890123456789012(36) 123456789
123456879012345 1. Dividend paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1. ________________________ .00
123456789012345 2. Taxable Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . ________________________ .00
3. Percentage of taxable income paid as dividend (DIVIDE Line 1 by Line 2. MULTIPLY the result by 100,
carry the result out to the sixth decimal place.) If taxable income is $0 or less, enter 100 .000000% . . 3. . __________123.123456______________%
123456789012345 4. Sales or gross receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . ________________________ .00
FORM (Place at FIRST page)
5. 123456789012345Business interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. . ________________________ .00 Form pages
123456789012345 6. Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . ________________________ .00
123456789012345 7. Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. . ________________________ .00
3 - 3
123456789012345 8. Other business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8. ________________________ .00
9. TOTAL INCOME, SALES, AND GROSS RECEIPTS
123456789012345(ADD Lines 4 through 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. . ________________________ .00
123456789012345 10. Sales and Receipts Increment(MULTIPLY Line 9 by Line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. . ________________________ .00
Name of Affiliate Affiliate’s FEIN
Affiliate #2
12345678901234567890123456789012(36) 123456789
123456879012345 11. Dividend paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. ________________________ .00
123456789012345 12. Taxable Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. . ________________________ .00
13. Percentage of taxable income paid as dividend (DIVIDE Line 11 by Line 12. MULTIPLY the result by 100,
carry the result out to the sixth decimal place.) If taxable income is $0 or less, enter 100 .000000% . 13. . __________123.123456______________%
123456789012345 14. Sales or gross receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. . ________________________ .00
123456789012345 15. Business interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. . ________________________ .00
123456789012345 16. Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. . ________________________ .00
17. 123456789012345Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. . ________________________ .00 FORM (Place atLAST page)
Form pages
123456789012345 18. Other business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18. ________________________ .00
19. TOTAL INCOME, SALES, AND GROSS RECEIPTS
123456789012345(ADD Lines 14 through 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. . ________________________ .00
123456789012345 20. Sales and Receipts Increment(MULTIPLY Line 19 by Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. . ________________________ .00
3 - 3
The sales and receipts increment (Lines 10 and 20 from all attached Schedules CO-420) Schedule CO-420
will be entered onto Line 2 of Schedule CO-419. Page 1 of 1
5454 Rev. 10/23