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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
Name of Affiliate Affiliate’s FEIN
Affiliate #1
1. Dividend paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. ________________________ .00
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. __________ . ______________%
4. Sales or gross receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. ________________________ .00
FORM (Place at FIRST page)
5. Business interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. ________________________ .00 Form pages
6. Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. ________________________ .00
7. Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. ________________________ .00
3 - 3
8. Other business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. ________________________ .00
9. TOTAL INCOME, SALES, AND GROSS RECEIPTS
(ADD Lines 4 through 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. ________________________ .00
10. Sales and Receipts Increment (MULTIPLY Line 9 by Line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. ________________________ .00
Name of Affiliate Affiliate’s FEIN
Affiliate #2
11. Dividend paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. ________________________ .00
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. __________ . ______________%
14. Sales or gross receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. ________________________ .00
15. Business interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. ________________________ .00
16. Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. ________________________ .00
17. Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17. ________________________ .00 FORM (Place at LAST page)
Form pages
18. Other business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18. ________________________ .00
19. TOTAL INCOME, SALES, AND GROSS RECEIPTS
(ADD Lines 14 through 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. ________________________ .00
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