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          4                          Vermont Department of Taxes                                                                                                                                                                                                          4
          5                                                                                                                                                                                                                                                               5
          6                       Schedule FIT-K-1VT-F                                                                                                                            *23K1F1100*                                                                             6
          7                                                                                                                                                                                                                                                               7
                            Vermont Beneficiary Information                                                                                                                       *23K1F1100*
          8                                                                                                                                                                                                                                                               8  Page 5
          9                                      for Fiduciaries                                                                                                                           Include with Form FIT-161                                                      9
          10                                                                                                                                                                                                                                                              10
          11                                                       Name of Estate or Trust                                                                                                 FEIN                                   Tax Year End Date (MM/DD/YYYY)          11
          12       123456789012345678901234567890123456      123456789        MM /       DD /                                                                                                                                                                 YYYY        12
          13                                                                                                                                                                                                                                                              13
          14                                                                                        HEADER INFORMATION - REQUIRED ITEMS                                                                                                                                   14
          15                                                                                           Entity Name                                                                                                                                  FEIN                  15
          16                                                                                                                                                                                                                                                              16
                     123456789012345678901234567890123456                  123456789
          17        OR                     Individual Last Name (Beneficiary)                                                                 First Name                                      Initial        OR                         Social Security Number            17
          18                                                                                                                                                                                                                                                              18
                     12345678901234567        12345678901234567     1      123456789
          19                                                                                        Address                                                                                                     Recipient Type                                            19
          20       123456789012345687901234567890123456                             (I, C, S, L, P, X, or T)                                                                                                                                                  I           20
          21                                                                         Address, Line 2 (if needed)                                                                                                Residency                                                 21
                                                                                                                                                                                                                                        Vermont 
          22       123456789012345678901234567890123456                     Status                                                                                                                                                X     Resident             XNonresident 22
          23                                                       City                                                                    State             ZIP Code or Postal Code                                                                                      23
          24       123456789012345678901            12   1234567890     X Check here if this your FINAL return                                                                                                                                                            24
          25                               Foreign Country (if not United States)                                                           Percentage of Estate’s or Trust’s income or loss to this recipient.                                                           25 FORM  (Place at FIRST page)
          26       12345678901234567890123456789012                              Calculate percentage to two places to the right of the decimal point.                                                                                              100.00     %          26 Form pages 
          27                                                                                                                                                                                                                                                              27
          28     VERMONT RESIDENT BENEFICIARY                                                                                                                                                                                                                             28
          29                                                                                                                                                                                                                                                              29
                                                                             123456789012  1. Beneficiary’s share of distributed net income allocated to Vermont   . . . . . . . . . . . . . . . . . . . . . 1..          ______________________.00
          30                                                                                                                                                                                                                                                              30
          31                                                                                                                                                                                                                                                              31
                                                                             123456789012  2. Interest / dividends from obligations of other states  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2..  ______________________.00                      5 - 5
          32                                                                                                                                                                                                                                                              32
          33                                                                                                                                                                                                                                                              33
                                                                             123456789012  3. Interest / dividends from U .S . obligations  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.. ______________________.00
          34                                                                                                                                                                                                                                                              34
          35     VERMONT NONRESIDENT BENEFICIARY                                                                                                                                                                                                                          35
          36                                                                                                                                                                                                                                                              36
                                                         123456789012    4a. Vermont Business Income  . . . . . . . . . . . . . . . . . . . . 4a.. ______________________                                 .00
          37                                                                                                                                                                                                                                                              37
          38                                                                                                                                                                                                                                                              38
                                                         123456789012    4b. Capital gain or loss allocated to Vermont  . . . . . . . . 4b..   ______________________                                     .00
          39                                                                                                                                                                                                                                                              39
          40                                                                                                                                                                                                                                                              40
                                                         123456789012    4c. Partnership, S Corporation, LLC  . . . . . . . . . . . . . . . 4c..  ______________________                                  .00
          41                                                                                                                                                                                                                                                              41
          42                                                                                                                                                                                                                                                              42
                                                         123456789012    4d. Rent, royalties, estates, trusts  . . . . . . . . . . . . . . . . . . 4d.. ______________________                            .00
          43                                                                                                                                                                                                                                                              43
          44                                                                                                                                                                                                                                                              44
                                                         123456789012    4e. Farm income  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .4e. ______________________                        .00
          45                                                                                                                                                                                                                                                              45
          46                                                                                                                                                                                                                                                              46
                                                         123456789012    4f. Other income  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4f.  ______________________                       .00
          47                                                                                                                                                                                                                                                              47
          48                                                                                                                                                                                                                                                              48
                                                                             123456789012  4g. Total nonresident income   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4g..  ______________________.00
          49                                                                                                                                                                                                                                                              49
          50     PAYMENT INFORMATION                                                                                                                                                                                                                                      50
          51                                                                                                                                                                                                                                                              51
                                                                             123456789012  5. Total annual nonresident estimated payments allocated to this beneficiary  . . . . . . . . . . . . . . . . 5..              ______________________.00
          52                                                                                                                                                                                                                                                              52
          53                                                                                                                                                                                                                                                              53
                                                                             123456789012  6. Total annual real estate withholding payments allocated to this beneficiary  . . . . . . . . . . . . . . .  .6.  ______________________.00
          54                                                                                                                                                                                                                                                              54
                   7.       Other payments allocated to this beneficiary (1099 withholding, estimates paid)  . . . . . . . . . . .  . 7.  ______________________.00                                                                                                          FORM
          55                                                                 123456789012                                                                                                                                                                                 55       (Place at LAST page)
          56                                                                                                                                                                                                                                                              56 Form pages 
          57       8.       Share of total federal bonus depreciation difference .                                                                                                                                                                                        57
                                                                             123456789012Enter on Schedule IN-112, Line 4 or Line 9 .   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8..  ______________________.00
          58                                                                                                                                                                                                                                                              58
          59                                                                                                                                                                                                                                                              59
                                                                             123456789012  9. Share of total state and local taxes deducted on federal filing   . . . . . . . . . . . . . . . . . . . . . . . . . . 9..   ______________________.00
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          61                                                                                                                                                                                                              Schedule FIT-K-1VT-F                            61
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