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4 Vermont Department of Taxes 4
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6 Schedule BI-472 *234721100* 6
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Vermont Non-Composite *234721100*
8 8 Page 5
9 Include with Form BI-471 9
PRINT in BLUE or BLACK INK
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11 Entity Name (same as on Form BI-471) Fiscal Year Ending (YYYYMMDD) FEIN 11
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12345678901234567890123456789012(36) 20231231 123456789
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15 Enter all amounts in whole dollars. 15
16 1. 123456789012345Income Attributable to Vermont (Schedule BI-477, Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1. ________________________.00 16
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18 2. 123456789012345Other adjustments to income attributable to Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. ________________________.00 18
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20 3. 123456789012345Total Income Attributable to Vermont(ADD Lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . ________________________.00 20
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22 4. Percentage of income from Line 3 passed through to nonresidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . __________100.000000______________% 22
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24 5. 123456789012345Total income passed through to nonresidents(MULTIPLY Line 3 by Line 4) . . . . . . . . . . . . . . . . . . . . . 5. . ________________________.00 24
25 25 FORM (Place at FIRST page)
26 6. 123456789012345 Nonresident estimated payment requirement(MULTIPLY Line 5 by 6.6% (0.066)) . . . . . . . . . . . . . . . . 6. . ________________________.00 26 Form pages
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46 46 FORM (Place at LAST page)
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Schedule BI-472
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63 5454 Rev. 10/23 63
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