Vermont Department of Taxes                                 Please PRINT 
                                                                  in BLUE or             DEPT 
      Form IN-116                                                 BLACK INK              USE  *231161100*
                                                                                         ONLY
Vermont Income Tax Payment Voucher                                                            *231161100*
      Taxpayer’s Last Name              First Name                                       MI             Taxpayer’s Social Security Number

 Spouse’s/CU Partner’s Last Name        First Name                                       MI   Spouse’s or CU Partner’s Social Security Number

           Mailing Address (Number and Street/Road or PO Box)                                           Tax Year
                                                                                              2023
      City                        State                           ZIP Code or Postal Code
                                                                                              Amount of 
                           Foreign Country (if not United States)                             this payment   . . . . .  . __________________________ .00

                                                                                                                                         Form IN-116
5454  If you electronically filed, DO NOT include a copy of the filed return with this payment .                                         Rev.10/23

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     Mail voucher and check made payable to “Vermont Department of Taxes” to: 
      Vermont Department of Taxes
      PO Box 1779
      Montpelier, VT  05601-1779