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4 Vermont Department of Taxes 4
5 5
6 Form BI-476 *234761100* 6
7 7
Vermont Business Income Tax Return *234761100*
8 8 Page 5
9 For Resident Only 9
10 Check Appropriate Name Address Accounting Extended Initial Return Pro Forma - Final Return 10
11 Box(es) X Change X Change X Period Change X Return X X Cannabis X (Cancels Account) 11
12 Entity Name (Principal Vermont Corporation) FEIN Primary 6-digit NAICS number 12
13 13
12345678901234567890123456789012(36) 123456789 123456
14 Address Tax year BEGIN date (YYYYMMDD) Tax year END date (YYYYMMDD) 14
15 15
12345678901234567890123456789012(36) 20230101 20231231
16 Address (Line 2) Federal tax return filed 16
17 12345678901234567890123456789012(36) (Check one box) X 1120S X 1065 X Other 17
18 City State ZIP Code Foreign Country 18
19 19
12345678901234567(21) 12 1234567890 1234567890123456789012345678(32)
20 20
21 A. Were any shareholders, partners, or members nonresidents of Vermont during this reporting tax year? . . . . . . . .A. X Yes X No 21
22 If Yes, STOP and complete Form BI-471, Business Income Tax Return . 22
23 B. Did this entity have income or losses derived from at least one state other than Vermont? . . . . . . . . . . . . . . . . . .B. X Yes X No 23
24 If Yes, STOP and complete Form BI-471, Business Income Tax Return . 24
C.
25 123456Total number of Vermont shareholders, partners, or members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C. ______________________ 25 FORM (Place atFIRST page)
26 26 Form pages
27 27
28 TAX COMPUTATION (see instructions) Enter all amounts in whole dollars. 28
29 1. Vermont minimum entity tax ($250) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. ________________________ .00 29
250
30 NOTE: If you qualify for an exception to the Vermont minimum entity tax, you must complete Form BI-471 and attach supporting documentation . 30
31 31
2. Payments previously made for this tax year with extension Form BA-403 or 5 - 5
32 123456789012345credit available through prior year carryforward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. ________________________.00 32
33 33
34 3. 123456789012345Balance Due (If Line 1 is greater than Line 2, Line 1 MINUS Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. ________________________.00 34
35 35
36 4. 123456789012345Overpayment (If Line 2 is greater than Line 1, Line 2 MINUS Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . ________________________.00 36
37 37
38 5. 123456789012345Overpayment to be Refunded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. . ________________________.00 38
39 39
40 6. 123456789012345Overpayment to be credited to next tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. . ________________________.00 40
41 41
I hereby certify that I am an officer or authorized agent responsible for the taxpayer’s compliance with the requirements Vermont Statutes
42 Annotated, Title 32, and that this return is true, correct, and complete to the best of my knowledge. If prepared by a person other than the 42
43 taxpayer, this declaration further provides that under 32 V.S.A. § 5901, this information has not been and will not be used for any other purpose, 43
44 or made available to any other person, other than for the preparation of this return unless a separate valid consent form is signed by the taxpayer 44
and retained by the preparer.
45 45
Signature of Responsible Officer Date (MM/DD/YYYY) Daytime Telephone Number
46 46
47 12 / 31 / 2023 802-123-1234 47
48 Printed Name Email Address (optional) 48
49 49
12345678901234567890123 1234567890123456789012345678901234567890123456
50 50
51 X Check if the Vermont Department of Taxes may discuss this return with the preparer shown. 51
52 52
Signature of Paid Preparer Date (MM/DD/YYYY) Preparer’s Telephone Number
53 53
54 12 / 31 / 2023 802-123-1234 54
55 Preparer’s Printed Name Email Address (optional) 55
56 12345678901234567890123 1234567890123456789012345678901234567890123456 56 FORM (Place at LAST page)
57 Firm’s Name (or yours if self-employed) EIN Preparer’s SSN or PTIN 57 Form pages
58 58
1234567980123456789012345678901234567890 123456789 123456789
59 Firm’s Address (or yours if self-employed) (Street, City, State, ZIP Code) 59
60 12345678901234567890123456789012345678901234567890123456 X Check if self-employed 60
61 61
62 Send return Vermont Department of Taxes For Department Use Only Form BI-476 62
and check to: 133 State Street Ck. Amt. Init. Page 1 of 1 5 - 5
63 Montpelier, VT 05633-1401 Rev. 10/23 63
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