Enlarge image
1 1
0 0 0 0 20 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
3 3
4 Vermont Department of Taxes 4
5 5
6 Form FIT-165 6
7 *211651100* 7
Vermont Fiduciary Estimated Tax
8 *211651100* 8 Page 1
9 Payment Voucher 9
10 Please PRINT in BLUE or BLACK INK 10
11 11
12 Name of Estate or Trust FEIN 12
13 13
123456789012345678901234567890123456 123456789
14 Name of Fiduciary Title of Fiduciary 14
15 15
123456789012345678901234567890123456 123456789012345
16 Mailing Address of Fiduciary (Number and Street/Road or PO Box) Tax year BEGIN date (MMDDYYYY) Tax year END date (MMDDYYYY) 16
17 123456789012345678901234567890123456 MM / DD / YYYY MM / DD / YYYY 17
18 Additional Line for Mailing Address of Fiduciary, if needed Check ONE 18
19 Estate Revocable Bankruptcy Grantor Irrevocable 19
123456789012345678901234567890123456 X X Trust X Estate X Trust X Trust
20 City State ZIP Code 20
21 21
12345678901234567890123 12 1234567890 Amount of
22 12345678901234 Foreign Country this payment .................. ____________________________ .00 22
23 23
12345678901234567890123456789012
24 24
25 25 FORM (Place at FIRST page)
MAIL THIS VOUCHER AND YOUR PAYMENT, ON OR BEFORE THE DUE DATE, TO THE ADDRESS BELOW.
26 26 Form pages
27 27
28 28
29 29
Form FIT-165
30 For Department Use Only 30
Page 1 of 1
31 Ck. Amt. Init. 31
Rev. 10/21 1 - 1
32 5454 32
33 33
34 34
35 35
36 36
37 37
38 FORM FIT-165 Instructions 38
39 Vermont Fiduciary Estimated Tax Payment Voucher 39
40 40
41 41
42 Payment Dates* 42
Estimated payments are required for estates and trusts. This voucher
43 1st payment ......APR 15 43
is provided for you to pay estimated payments toward your fiduciary tax
44 2nd payment .....JUN 15 44
45 liability. Please complete the coupon above with all information on the estate 45
46 or trust including the Federal ID Number, and send it to the address below. 3rd payment ......SEP 15 46
47 4th payment ......JAN 15 47
48 *If the due date falls on a weekend or a 48
49 holiday, the payment and voucher are due 49
50 50
the next business day.
51 51
52 52
53 Mail payment voucher to: 53 FORM (Place at LAST page)
54 54 Form pages
55 Taxpayer Email: tax.estate@vermont.gov55 Services Division-Income Tax
56 Vermont Telephone: 56 Department(802)of828-6820Taxes
57 PO Fax: (802)57 Box828-27201700
58 Montpelier,58 VT 05601-1700
59 59 1 - 1
60 60
61 61
62 Form FIT-165 Instructions 62
63 Rev. 10/23 63
0 0 0 0 640 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 64
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
65 65
66 66