Vermont Department of Taxes 

                  Schedule K-1VT                                                                                                            *23K1V1100*

       Vermont Shareholder, Partner, or                                                                                                     *23K1V1100*
                                                                                                                                                                                                                                                    Page 7
                  Member Information                                                                                                              This schedule is REQUIRED.
                                                                                                                                                    Include with Form BI-471

                       Entity Name (same as on Form BI-471)                                                     Fiscal Year Ending (YYYYMMDD)                                                                               FEIN
  12345678901234567890123456789012(36)       20231231        123456789

                                          HEADER INFORMATION - REQUIRED ENTRIES
                                        Entity Name (Shareholder, Partner, or Member)                                                                                                                                       FEIN
    12345678901234567890123456789012(36)                  123456789
 OR    Individual Last Name (Shareholder, Partner, or Member)                               First Name                              Initial   OR                                                                 Social Security Number
    12345678901234567       12345678901234567     1       123456789
                                                            Address                                                                               Recipient Type 
  12345678901234567890123456789012(36)                             (I, C, S, L, P, X, or T)                                                                                                                                      1
                                                Address, Line 2 (if needed)                                                                       Residency Status
  12345678901234567890123456789012(36)
                                  City                                                    State                   ZIP Code                                      Vermont Resident                                                                    FORM  (Place at FIRST page)
                                                         X
  12345678901234567(21)            12   1234567890                                                                                                                                                                                                  Form pages 
                                          Foreign Country (if not United States)                                                                                Nonresident
                                                         X
  1234567890123456789012345678(32)
PART I       PASS-THROUGH ENTITY INFORMATION
                                                            1. Ownership percentage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. . _______123.123456______________%        7 - 8

                                                            2. Profit  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . _______123.123456______________%                                         percentage 

                                                            3. Loss percentage  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . _______123.123456______________%

                                                           4. Disregarded  . . . . . . . . . . . 4..                                                            X      Yes                                                  X    No                                            entity (single-member LLC or Qualified Subchapter S subsidiary)?

                                                           5. Is  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.. X      Yes                                                X    No                                            this entity a unit of a Series LLC?

                                                           6. Did  . . . . . . . . . . . . . . . . . . . . . 6..                                                X      Yes                                                  X    No                                            this entity pay tax on this income as part of a composite return?

PART II  DISTRIBUTIONS TO OWNERS                                                                                                        Enter all amounts in whole dollars.

                                                         123456789012345 7. Vermont Business Income  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . 7. . ______________________.00

                                                         123456789012345  8. Capital gains allocated to Vermont  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. . ______________________.00

                                                         123456789012345  9. Other income allocated to Vermont   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. . ______________________.00
  10.  Exempt Income - Vermont income not characterized as Unrelated 
                                                         123456789012345Business Income (UBI) for federal purposes (tax-exempt entities only)   . . . . . . . . . . . . . . . . . 10. . ______________________.00

                                                         123456789012345  11.  Total annual nonresident estimated payments allocated to this shareholder  . . . . . . . . . . . . . . . 11. . ______________________.00

                                                         123456789012345  12. Total annual real estate withholding payments allocated to this shareholder    . . . . . . . . . . . . . 12. . ______________________.00
  13.  Share of total federal bonus depreciation difference.   
                                                         123456789012345Enter  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. . ______________________.00                                                                                     on Schedule IN-112, Line 4 or Line 9. 

                                                         123456789012345  14.    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14. .       ______________________.00                                                                                             Share of total state and local taxes deducted difference 

                                                                          (continued on next page)                                                                                                               Schedule K-1VT
                                                                                                                                                                                                                           Page 1 of 2
5454                                                                                                                                                                                                                        Rev. 10/23

                 Entity Name (same as on Form Form BI-471)
 12345678901234567890123456789012(36)
                     FEIN                                  Fiscal Year Ending (YYYYMMDD)                                     *23K1V1200*
   123456789              20231231                                                                                           *23K1V1200*
                                                                                                                                                                                                         Page 8

PART III  DISTRIBUTIVE SHARE OF APPORTIONMENT FACTORS
                                                                                                A.  Everywhere                                                B.  Vermont

                              15.  Sales  . . . . . . . . . . . . . . . . . . . . . . . . 15A. ._________________________123456789012345            .00 15B.  _________________________123456789012345.00

                              16.  Payroll   . . . . . . . . . . . . . . . . . . . . . . 16A. ._________________________123456789012345            .00 16B.  _________________________123456789012345 .00

                              17.  Property  . . . . . . . . . . . . . . . . . . . . . 17A. ._________________________123456789012345            .00 17B.  _________________________123456789012345   .00

                                                                                                                                                                                                         FORM  (Place at LAST page)
                                                                                                                                                                                                         Form pages 

                                                                                                                                                                                                         7 - 8

                                                                                                                                                              Schedule K-1VT
                                                                                                                                                              Page 2 of 2
5454                                                                                                                                                          Rev. 10/23