DEPT 
             Vermont Department of Taxes                                        USE                                                                                          FILE YOUR RETURN 
                                                                                ONLY                                                                                         ELECTRONICALLY FOR A 
                   2023 Form IN-111                                                     *231111100*                                                                          FASTER REFUND. GO TO  
                                                                                                                                                                             TAX.VERMONT.GOV FOR 
          Vermont Income Tax Return                                                     *231111100*                                                                          MORE INFORMATION.
                                                                             Please PRINT in BLUE or BLACK INK                                                                                                   Page 19
             Taxpayer’s Last Name                                               First Name                                  MI              Social Security Number    
                                                                                                                                                                                              Check if 
                                                                                                                                                                                              Deceased
          Spouse’s/CU Partner’s Last Name                                       First Name                                  MI              Social Security Number    
                                                                                                                                                                                              Check if 
                                                                                                                                                                                              Deceased
                               Mailing Address (Number and Street/Road or PO Box)                                              911/Physical Street Address on 12/31/2023
                                                                                                                                                                                                                 FORM  (Place at FIRST page)
                         City                                          State ZIP Code or Foreign Postal Code                                                              Foreign Country                        Form pages 

  Vermont School District Code                                                  Check all            AMENDED                CANNABIS                                      RECOMPUTED          EXTENDED 
                                   Enter Healthcare Coverage Code                                                           With Recomputed 
                                   (See instructions for code options)          that apply           Return                 Federal Return                                Return              Return
 Filing Status and       Single               Married/CU Filing Jointly                             Married/CU Filing          Head of Household                                 Qualifying Widow(er) 
 Standard Deduction      ($7,000)             ($14,050)                                             Separately ($7,000)        ($10,550)                                         ($14,050)                       19 - 20
  Vermont Residency Status as of 12/31/2023 (check one)                RESIDENT                      PART-YEAR 
                                                                                                     RESIDENT                                NONRESIDENT

 1.  Federal Adjusted Gross Income (federal Form 1040, Line 11)  . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 1.  __________________________ .00

 2.  Net Modifications to Federal AGI (Schedule IN-112, Part I, Line 18)  . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 2.  __________________________ .00

 3.  Federal AGI with Modifications (ADD Lines 1 and 2)  . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 3.  __________________________ .00

 4.  2023 Vermont Standard Deduction from filing status section above .  . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 4.  __________________________ .00 
          Please see instructions if you or your spouse checked any standard 
          deduction boxes on federal Form 1040, page 1 .
 5. Personal Exemptions:
      5a.  Enter "1" for yourself if no one                   5b.  Enter "1" for your jointly filed         5c.  Enter number of OTHER                                                      5d.  Total Exemptions
      can claim you as a dependent            spouse or CU partner if no one can                                       dependents claimed on                                     (ADD Lines 5a through 5c)
                                                              claim them as a dependent                                    federal Form 1040
     5a.  ________                                         +  5b.  ________                                         +  5c. ________                                          =   5d. __________ 

 5e. MULTIPLY Line 5d by $4,850              (2023 Personal Exemption)  . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 5e. .  . __________________________.  .                     .00

  6.  ADD Lines 4 and 5e   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 6.  __________________________ .00

 7.  Vermont Taxable Income (SUBTRACT Line 6 from Line 3.  If less than zero, enter -0-)  . . . . . . . . . .  . 7.  __________________________ .00

  8. Vermont Income Tax from tax table or tax rate schedule   . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 8.  __________________________ .00 
     (If Line 1 is greater than $150,000, see instructions)
  9. Net Adjustment to Vermont Tax (Schedule IN-119, Part I, Line 15)  . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 9.  __________________________ .00

 10. Vermont Income Tax with Adjustment (ADD Lines 8 and 9.  If less than zero, enter -0-)  . . . . . . . . .  . 10.  __________________________ .00
  11.  Tax-Deductible Charitable Contribution                     12.  Multiply Line 11 by 5% (0.05) 13.  Charitable Contribution 
      (See instructions)                                                                                    Deduction (Enter the lesser 
                         ___________ .00                               ___________ .00                      of Line 12 or $1,000)  ......  13.  __________________________ .00

 14. Vermont Income Tax (Line 10 MINUS Line 13.  If less than zero, enter -0-)    . . . . . . . . . . . . . . . . . .  . 14.  __________________________ .00

 15.  Income Adjustment (Schedule IN-113, Line 35, or 100 .0000%)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .15.  _______ . _________%

 16. Adjusted Vermont Income Tax (MULTIPLY Line 14 by Line 15)  . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 16.   _____________________________.00

                                                                                                                                                                                 Form IN-111
                                                                       Amount Due                                                                                                Page 1 of 2
              5454                                                     (from Line 31)                                          .00                                               Rev. 10/23

                           Taxpayer’s Last Name             Social Security Number

                                                                                                              *231111200*
       Amount from  
       Line 16                                  .00                                                           *231111200*
                                                                                                                                                                                                      Page 20
       Other State Credit (Schedule IN-117, Line 21)        Vermont Tax Credits (Schedule IN-119, Part II)                                                 Total Vermont Credits (Add Lines 17 and 18)
 17.  _____________________    .00                   +      18. ____________________ .00                           =           19.  __________________________ .00
 20.   Vermont Income Tax after credits  (SUBTRACT Line 19 from Line 16. 
       If Line 19 is greater than Line 16, enter -0-)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 20.  __________________________ .00
 21.   Use Tax for taxable items on which no sales tax was charged,                              Check to certify  
       including online purchases . (See instructions, worksheet, and chart)  . . .              no Use Tax is due.  OR        21.  __________________________ .00
                                                                                                                                                                                                      FORM  (Place at LAST page)
 22.   Total Vermont Taxes (ADD Lines 20 and 21)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 22.  __________________________ .00                         Form pages 
  Nongame Wildlife Fund                 Vermont Children’s                 Vermont Veterans Fund                   Green Up Vermont                                              Total Contributions
                                        Trust Foundation
23a.   __________.00           +   23b. __________       .00           +   23c.  __________ .00           +   23d. __________                              .00                 = 23e. __________.00 

 24.   Total of Vermont Taxes and Voluntary Contributions (ADD Lines 22 and 23e)  . . . . . . . . . . . . . . . . .  . 24.  __________________________ .00                                            19 - 20

25a.   2023 Vermont Tax Withheld from W-2, 1099  . . . . . . . . . . . . . . . . . . .      25a.  __________________ .00
  25b. 2023 Estimated Tax payments, amount carried forward from 2022,  
       and/or payment made with 2023 extension  . . . . . . . . . . . . . . . . . . . . . . 25b.  __________________ .00
  25c.  Refundable Credits (Schedule IN-112, Part II:   
       Full-Year Residents-Line 8; Part-Year Residents-Line 12)  . . . . . . .  .25c.  __________________ .00

  25d. 2023 Vermont Real Estate Withholding from Form RW-171  . . . . . . . 25d.  __________________ .00
  25e. 2023 Nonresident Estimated Tax payments 
       (nonresident withholding) allocated on Schedule K-1VT, Line 5  . . . .  .25e.  __________________ .00

  25f. Total Payments and Credits (ADD Lines 25a through 25e)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25f.  __________________________ .00

 26.   Overpayment . If Line 24 is less than Line 25f, SUBTRACT Line 24 from Line 25f  . . . . . . . . . . .  . 26.  __________________________ .00

  27a.  Refund to be credited to 2024 Estimated Tax Payment  . . . . . . . . . . . .        27a.  __________________ .00

  27b. Refund to be credited to 2024 Property Tax Bill  . . . . . . . . . . . . . . . . . 27b.  __________________ .00

 28.   REFUND AMOUNT (  SUBTRACT Lines 27a and 27b from Line 26)  . . . . . . . . . . . . . . . . . . . . . .  . 28.  __________________________ .00
 29.  If Line 24 is more than Line 25f, subtract Line 25f from Line 24. 
       See instructions on tax due  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 29.  __________________________ .00
 30.  Interest and Penalty on                                                               31.  AMOUNT DUE
    Underpayment of Estimated Tax                 . .30. _________________.00                    (ADD Lines 29 and 30)31.                                  __________________________           .00 
       (Worksheet IN-152 or IN-152A)

  For Amended       Original refund received                Refund due now                       Original payment                                              Amount due now
  Returns Only:                                      .00                                    .00                                                            .00                                  .00
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 
belief, they are true, correct and complete. Preparers cannot use return information for purposes other than preparing returns.

 Signature                                                                       Date (MM/DD/YYYY)        Date of Birth (MM/DD/YYYY)                            Daytime Telephone Number
                                                                                  /         /                      /        /
 Signature (If a joint return, BOTH must sign.)                                  Date (MM/DD/YYYY)        Date of Birth (MM/DD/YYYY)                            Daytime Telephone Number
                                                                                  /         /                      /        /
 Paid Preparer’s Signature                                                                                Date (MM/DD/YYYY)                                     Preparer’s Telephone Number
                                                                                                                   /        /
 Firm’s Name (or yours if self-employed) and address                                                      Preparer’s SSN or PTIN                                FEIN

                                                                                                                                                                Form IN-111
               Check if the Department of Taxes may discuss this return with the preparer shown.          Keep a copy for                                                        Page 2 of 2
               5454                                                                                       your records.                                                          Rev. 10/23

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