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                                                                                                                     DEPT                                                                                                                                                              3
          4                           Vermont Department of Taxes                                                               USE                                                                                                FILE YOUR RETURN                                               4
          5                                                                                                                     ONLY                                                                                               ELECTRONICALLY FOR A                                           5
          6                                 2023 Form IN-111                                                                                   *231111100*                                                                         FASTER REFUND. GO TO                                           6
          7                                                                                                                                                                                                                        TAX.VERMONT.GOV FOR                                            7
                                 Vermont Income Tax Return                                                                                     * 23 1111100*                                                                       MORE INFORMATION.
          8                                                                                                            Please PRINT in BLUE or BLACK INK                                                                                                                                          8  Page 19
          9                                                                                                                                                                                                                                                                                       9
          10                          Taxpayer’s Last Name                                                                         First Name                                      MI                      Social Security Number                                                                 10
          11                                                                                                                                                                                                                                                    Check if                          11
                   1234567890123(17)       1234567890123(17)    1   123456789        X Deceased
          12                     Spouse’s/CU Partner’s Last Name                                                                   First Name                                      MI                      Social Security Number                                                                 12
          13                                                                                                                                                                                                                                                    Check if                          13
                   1234567890123(17)       1234567890123(17)    1   123456789        X Deceased
          14                                                  Mailing Address (Number and Street/Road or PO Box)                                                                                     911/Physical Street Address on 12/31/2023                                                    14
          15       1234567890123456789012345678                 12345678901234567890123(27)                                                                                                                                                                                                       15 FORM  (Place at FIRST page)
          16                                            City                                               State          ZIP Code or Foreign Postal Code                                                                 Foreign Country                                                         16 Form pages 
          17                                                                                                                                                                                                                                                                                      17
                   123456748901234567(21)   12   1234567890     123456789012345678(22) 
          18       Vermont School District Code                                                                                 Check all               AMENDED                       CANNABIS                                  RECOMPUTED                      EXTENDED                          18
          19                                                              Enter Healthcare Coverage Code                                                                              With Recomputed                                                                                             19
          20       123          1                    (See instructions for code options)                                        that apply        X       Return                   X         Federal Return               X         Return                     XReturn                            20
          21        Filing Status and                   Single                           Married/CU Filing Jointly                                Married/CU Filing                                  Head of Household                            Qualifying Widow(er)                            21
                            Standard Deduction       X       ($7,000)              X              ($14,050)                                    X            Separately ($7,000)                X          ($10,550)                         X     ($14,050)                                          19 - 20
          22         Vermont Residency Status as of 12/31/2023 (check one)                                          RESIDENT                                  PART-YEAR                                                                                                                           22
          23                                X           X           RESIDENT                                                                                                                            X     NONRESIDENT                                                                         23
          24                                                                                                                                                                                                                                                                                      24
          25                                                                                                                                                                                                                                                                                      25
          26                                                               1234567890123451. Federal Adjusted Gross Income (federal Form 1040, Line 11)  . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 1. . __________________________.  .  .                 .00            26
          27                                                                                                                                                                                                                                                                                      27
          28                                                               1234567890123452. Net Modifications to Federal AGI (Schedule IN-112, Part I, Line 18)  . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 2. . __________________________.  .  .                    .00            28
          29                                                                                                                                                                                                                                                                                      29
          30                                                               1234567890123453.  Federal AGI with Modifications (ADD Lines 1 and 2)  . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 3. .  . __________________________.  .  .            .00            30
          31                                                                                                                                                                                                                                                                                      31
          32                                                               1234567890123454.  2023 Vermont Standard Deduction from filing status section above .  . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 4. . __________________________.  .  .                  .00            32
          33                     Please see instructions if you or your spouse checked any standard                                                                                                                                                                                               33
                                 deduction boxes on federal Form 1040, page 1 .
          34        5. Personal Exemptions:                                                                                                                                                                                                                                                       34
          35                                                                                   5b.  Enter "1" for your jointly filed                                   5c.  Enter number of OTHER                                                                                                 35
          36                 5a.  Enter "1" for yourself if no one                          spouse or CU partner if no one can                                            dependents claimed on                                                      5d.  Total Exemptions                        36
                             can claim you as a dependent                                                                                                                                                                                         (ADD Lines 5a through 5c)
          37                                                                                      claim them as a dependent                                                  federal Form 1040                                                                                                    37
          38                5a.  ________                                         1                   +  5b.  ________                                         1                  +  5c. ________                                          12                  =  5d. __________ 12               38
          39                                                                                                                                                                                                                                                                                      39
          40                                                               1234567890123455e. MULTIPLY Line 5d by $4,850 (2023 Personal Exemption)  . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 5e. .  . __________________________.  .                      .00            40
          41                                                                                                                                                                                                                                                                                      41
          42                                                                1234567890123456.  ADD Lines 4 and 5e   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 6. .  . __________________________.  .  . .00 42
          43                                                                                                                                                                                                                                                                                      43
          44                                                               1234567890123457. Vermont Taxable Income (SUBTRACT Line 6 from Line 3.  If less than zero, enter -0-)  . . . . . . . . . . 7. .          __________________________.00                                                 44
          45                                                                                                                                                                                                                                                                                      45
          46       8.                                                         123456789012345Vermont Income Tax from tax table or tax rate schedule   . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 8. .  . __________________________.  .  .            .00            46
          47                (If Line 1 is greater than $150,000, see instructions)                                                                                                                                                                                                                47
          48       9.                                                         123456789012345Net Adjustment to Vermont Tax (Schedule IN-119, Part I, Line 15)  . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 9. .  . __________________________.  .  .                   .00            48
          49                                                                                                                                                                                                                                                                                      49
          50                                                               12345678901234510. Vermont Income Tax with Adjustment (ADD Lines 8 and 9.  If less than zero, enter -0-)  . . . . . . . . .  .10.  __________________________.00                                                       50
          51                                                                                                                                                                                                                                                                                      51
          52           11.  Tax-Deductible Charitable Contribution                                   12.  Multiply Line 11 by 5% (0.05)                    13.  Charitable Contribution                                                                                                           52
                             (See instructions)                                                                                                                     Deduction (Enter the lesser 
          53                                            12345678      ___________ .00                         ___________12345678                     .00           of Line 12 or $1,000)  ......             13.  __________________________123456789012345                       .00            53
          54                                                                                                                                                                                                                                                                                      54
          55      14.                                                         123456789012345Vermont Income Tax (Line 10 MINUS Line 13.  If less than zero, enter -0-)    . . . . . . . . . . . . . . . . . . 14. . __________________________.00                                                 55
          56                                                                                                                                                                                                                                                                                      56
          57                                                                     15.  Income Adjustment (Schedule IN-113, Line 35, or 100 .0000%)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  . 15. .  . _______.100.0000_________%                           57
          58                                                                                                                                                                                                                                                                                      58
          59      16.                                                         123456789012345Adjusted Vermont Income Tax (MULTIPLY Line 14 by Line 15)  . . . . . . . . . . . . . . . . . . . . . . . . . . . 16..    _____________________________.00                                            59
          60                                                                                                                                                                                                                                                                                      60
          61                                                                                                                                                                                                                                Form IN-111                                           61
          62                                                                                                     Amount Due                                                                                                                    Page 1 of 2                                        62
          63                                       1234567890123455454                                           (from Line 31)                                                                .00                                                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

          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                                            Taxpayer’s Last Name                                     Social Security Number                                                                                                                                         4
          5                                                                                                                                                                                                                                                                    5
                        1234567890123(17)    123456789 
          6                                                                                                                                                                             *231111200*                                                                            6
          7                 Amount from                                                                                                                                                                                                                                        7
                          123456789012Line 16                                           .00                                                                                             * 23 1111200*
          8                                                                                                                                                                                                                                                                    8  Page 20
          9                 Other State Credit (Schedule IN-117, Line 21)                                          Vermont Tax Credits (Schedule IN-119, Part II)                                                  Total Vermont Credits (Add Lines 17 and 18)                 9
          10         17.  _____________________123456789012             .00                   +              18. ____________________123456789012               .00                        =                 19.  __________________________123456789012345       .00          10
          11                                                                                                                                                                                                                                                                   11
                  20.       Vermont Income Tax after credits  (SUBTRACT Line 19 from Line 16. 
          12                                                              123456789012345If Line 19 is greater than Line 16, enter -0-)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. . __________________________.00         12
          13                                                                                                                                                                                                                                                                   13
                  21.       Use Tax for taxable items on which no sales tax was charged,                                                                        Check to certify  
          14                                             including online purchases . (See instructions, worksheet, and chart)  . . .                     X                    no Use Tax is due. OR         21.  __________________________1234567890            .00          14
          15                                                                                                                                                                                                                                                                   15 FORM  (Place at LAST page)
          16      22.                                                         123456789012345Total Vermont Taxes (ADD Lines 20 and 21)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. . __________________________.00               16 Form pages 
          17           Nongame Wildlife Fund                                Vermont Children’s                                                                                                                                                                                 17
                                                                                                                               Vermont Veterans Fund                                       Green Up Vermont                                         Total Contributions
          18                                                                Trust Foundation                                                                                                                                                                                   18
          19         23a.   __________12345         .00           +   23b. __________12345         .00           +   23c.  __________12345          .00           +   23d. __________12345           .00                 =                    23e. __________12345.00          19
          20                                                                                                                                                                                                                                                                   20
          21      24.                                                         123456789012345Total of Vermont Taxes and Voluntary Contributions (ADD Lines 22 and 23e)  . . . . . . . . . . . . . . . . . 24. .    __________________________.00                               21
                                                                                                                                                                                                                                                                                  19 - 20
          22                                                                                                                                                                                                                                                                   22
          23     25a.                                          123456789012023 Vermont Tax Withheld from W-2, 1099  . . . . . . . . . . . . . . . . . . .25a.  __________________                         .00                                                                  23
          24                                                                                                                                                                                                                                                                   24
                   25b.     2023 Estimated Tax payments, amount carried forward from 2022,  
          25                                               12345678901and/or payment made with 2023 extension  . . . . . . . . . . . . . . . . . . . . . .25b.  __________________                        .00                                                                  25
          26                                                                                                                                                                                                                                                                   26
                   25c.  Refundable Credits (Schedule IN-112, Part II:   
          27                                               12345678901Full-Year Residents-Line 8;Part-Year Residents-Line 12)  . . . . . . . 25c. .             __________________                        .00                                                                  27
          28                                                                                                                                                                                                                                                                   28
          29       25d.                                          123456789012023 Vermont Real Estate Withholding from Form RW-171  . . . . . . . 25d.  __________________                                 .00                                                                  29
          30                                                                                                                                                                                                                                                                   30
                   25e.     2023 Nonresident Estimated Tax payments 
          31                                               12345678901(nonresident withholding) allocated on Schedule K-1VT, Line 5  . . . . 25e. .             __________________                        .00                                                                  31
          32                                                                                                                                                                                                                                                                   32
          33       25f.                                                         123456789012345Total Payments and Credits (ADD Lines 25a through 25e)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25f.  __________________________.00                      33
          34                                                                                                                                                                                                                                                                   34
          35      26.                                                         123456789012345Overpayment .If Line 24 is less than Line 25f, SUBTRACT Line 24 from Line 25f  . . . . . . . . . . . 26. .            __________________________.00                               35
          36                                                                                                                                                                                                                                                                   36
          37       27a.                                          12345678901  Refund to be credited to 2024 Estimated Tax Payment  . . . . . . . . . . . . 27a.  __________________                       .00                                                                  37
          38                                                                                                                                                                                                                                                                   38
          39       27b.                                          12345678901Refund to be credited to 2024 Property Tax Bill  . . . . . . . . . . . . . . . . . 27b.  __________________                   .00                                                                  39
          40                                                                                                                                                                                                                                                                   40
          41      28.                                                         123456789012345REFUND AMOUNT  (SUBTRACT Lines 27a and 27b from Line 26   )  . . . . . . . . . . . . . . . . . . . . . . 28. .        __________________________.00                               41
          42                                                                                                                                                                                                                                                                   42
                  29.  If Line 24 is more than Line 25f, subtract Line 25f from Line 24. 
          43                                                              123456789012345See instructions on tax due  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .29.  __________________________.00 43
          44                                                                                                                                                                                                                                                                   44
                  30.  Interest and Penalty on                                                                                                         31.  AMOUNT DUE
          45                                 Underpayment of Estimated Tax             . .30. _________________123456789                      .00               (ADD Lines 29 and 30)31.                           __________________________123456789012345      .00          45
          46                (Worksheet IN-152 or IN-152A)                                                                                                                                                                                                                      46
          47                                                                                                                                                                                                                                                                   47
          48           For Amended               Original refund received                                 Refund due now                                              Original payment                                         Amount due now                                  48
          49               Returns Only:      123456789012    .00                                            123456789012   .00                                       123456789012    .00                                         123456789012                    .00          49
          50                                                                                                                                                                                                                                                                   50
                 Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
          51     belief, they are true, correct and complete. Preparers cannot use return information for purposes other than preparing returns.                                                                                                                               51
          52                                                                                                                                                                                                                                                                   52
          53        Signature                                                                                                           Date (MM/DD/YYYY)                         Date of Birth (MM/DD/YYYY)                            Daytime Telephone Number               53
          54                                       MM DD YYYY  MM /       DD /                                                                                                                               YYYY   123-123-1234                                               54
          55        Signature (If a joint return, BOTH must sign.)                                                                      Date (MM/DD/YYYY)                         Date of Birth (MM/DD/YYYY)                            Daytime Telephone Number               55
          56                                       MM DD YYYY  MM /       DD /                                                                                                                               YYYY   123-123-1234                                               56
          57        Paid Preparer’s Signature                                                                                                                                     Date (MM/DD/YYYY)                                     Preparer’s Telephone Number            57
          58                                                   MM /       DD /                                                                                                                               YYYY   123-123-1234                                               58
          59        Firm’s Name (or yours if self-employed) and address                                                                                                           Preparer’s SSN or PTIN                                FEIN                                   59
          60                                                                                                                                                                                                                                                                   60
                  123456789012345678901234567890123456          123456789      123456789
          61                                                                                                                                                                                                                               Form IN-111                         61
          62           X Check if the Department of Taxes may discuss this return with the preparer shown.                                                                     Keep a copy for                                                Page 2 of 2                      62
          63                            5454                                                                                                                                   your records.                                                     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