DEPT 
              Vermont Department of Taxes                                                       USE                                                                                        FILE YOUR RETURN 
                                                                                                ONLY                                                                                       ELECTRONICALLY FOR A 
                    2023 Form IN-111                                                                   *231111100*                                                                         FASTER REFUND. GO TO  
                                                                                                                                                                                           TAX.VERMONT.GOV FOR 
           Vermont Income Tax Return                                                                   * 23 1111100*                                                                       MORE INFORMATION.
                                                                                             Please PRINT in BLUE or BLACK INK                                                                                                                                                 Page 19
               Taxpayer’s Last Name                                                             First Name                                            MI                     Social Security Number    
                                                                                                                                                                                                                                         Check if 
  1234567890123(17)       1234567890123(17)    1   123456789        X Deceased
           Spouse’s/CU Partner’s Last Name                                                      First Name                                            MI                     Social Security Number    
                                                                                                                                                                                                                                         Check if 
  1234567890123(17)       1234567890123(17)    1   123456789        X Deceased
                               Mailing Address (Number and Street/Road or PO Box)                                                                                        911/Physical Street Address on 12/31/2023
  1234567890123456789012345678                 12345678901234567890123(27)                                                                                                                                                                                                     FORM  (Place at FIRST page)
                              City                                           State           ZIP Code or Foreign Postal Code                                                      Foreign Country                                                                              Form pages 
  123456748901234567(21)   12   1234567890     123456789012345678(22) 
  Vermont School District Code                                                                  Check all      AMENDED                                CANNABIS                    RECOMPUTED                                             EXTENDED 
                                         Enter Healthcare Coverage Code                                                                               With Recomputed 
  123          1                    (See instructions for code options)                         that apply X       Return                             X         Federal Return    X         Return                                      XReturn
  Filing Status and           Single                   Married/CU Filing Jointly                           Married/CU Filing                                             Head of Household                                   Qualifying Widow(er) 
           Standard Deduction X       ($7,000)     X              ($14,050)                            X            Separately ($7,000)                                  X          ($10,550) X                              ($14,050)                                         19 - 20
   Vermont Residency Status as of 12/31/2023 (check one)                       RESIDENT                              PART-YEAR 
                           X           X           RESIDENT                                                                                                              X   NONRESIDENT

                                                         123456789012345 1. Federal Adjusted Gross Income (federal Form 1040, Line 11)  . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 1. . __________________________.  .  .                 .00

                                                         123456789012345 2. Net Modifications to Federal AGI (Schedule IN-112, Part I, Line 18)  . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 2. . __________________________.  .  .                    .00

                                                         123456789012345 3.  Federal AGI with Modifications (ADD Lines 1 and 2)  . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 3. .  . __________________________.  .  .            .00

                                                         123456789012345 4.  2023 Vermont Standard Deduction from filing status section above .  . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  . 4. . __________________________.  .  .                  .00 
           Please see instructions if you or your spouse checked any standard 
           deduction boxes on federal Form 1040, page 1 .
  5. Personal Exemptions:
       5a.  Enter "1" for yourself if no one                        5b.  Enter "1" for your jointly filed                  5c.  Enter number of OTHER                                                                        5d.  Total Exemptions
       can claim you as a dependent                        spouse or CU partner if no one can                                                    dependents claimed on                                                       (ADD Lines 5a through 5c)
                                                                    claim them as a dependent                                                        federal Form 1040
           5a.  ________                                         1                   +  5b.  ________                                         1                  +  5c. ________                                          12                  =  5d. __________ 12

                                                         123456789012345 5e. MULTIPLY Line 5d by $4,850 (2023 Personal Exemption)  . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 5e. .  . __________________________.  .                      .00

                                                           1234567890123456.  ADD Lines 4 and 5e  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 6. .  . __________________________.  .  . .00

                                                         123456789012345 7. Vermont Taxable Income (SUBTRACT Line 6 from Line 3.  If less than zero, enter -0-)  . . . . . . . . . . 7. . __________________________.00

                                                         123456789012345  8. Vermont Income Tax from tax table or tax rate schedule   . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 8. .  . __________________________.  .  .           .00 
      (If Line 1 is greater than $150,000, see instructions)
                                                         123456789012345  9. Net Adjustment to Vermont Tax (Schedule IN-119, Part I, Line 15)  . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  . 9. .  . __________________________.  .  .                  .00

                                                         123456789012345 10. Vermont Income Tax with Adjustment (ADD Lines 8 and 9.  If less than zero, enter -0-)  . . . . . . . . .  .10.  __________________________.00
   11.  Tax-Deductible Charitable Contribution                          12.  Multiply Line 11 by 5% (0.05)         13.  Charitable Contribution 
       (See instructions)                                                                                                Deduction (Enter the lesser 
                              12345678      ___________ .00                  ___________12345678                     .00 of Line 12 or $1,000)  ......                       13.  __________________________123456789012345                                       .00

                                                         123456789012345 14. Vermont Income Tax (Line 10 MINUS Line 13.  If less than zero, enter -0-)    . . . . . . . . . . . . . . . . . . 14. . __________________________.00

                                                                15.  Income Adjustment (Schedule IN-113, Line 35, or 100 .0000%)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  . 15. .  . _______.100.0000_________%

                                                         123456789012345 16. Adjusted Vermont Income Tax (MULTIPLY Line 14 by Line 15)  . . . . . . . . . . . . . . . . . . . . . . . . . . . 16..   _____________________________.00

                                                                                                                                                                                              Form IN-111
                                                                             Amount Due                                                                                                                                      Page 1 of 2
                                  1234567890123455454                        (from Line 31)                                                                              .00                                                 Rev. 10/23

                           Taxpayer’s Last Name                       Social Security Number
       1234567890123(17)    123456789 
                                                                                                                                        *231111200*
         Amount from  
         123456789012Line 16                             .00                                                                            * 23 1111200*
                                                                                                                                                                                                                                                             Page 20
       Other State Credit (Schedule IN-117, Line 21)                      Vermont Tax Credits (Schedule IN-119, Part II)                                                   Total Vermont Credits (Add Lines 17 and 18)
    17.  _____________________123456789012             .00    +       18. ____________________123456789012               .00              =                             19.  __________________________123456789012345          .00
 20.     Vermont Income Tax after credits  (SUBTRACT Line 19 from Line 16. 
                                                         123456789012345If Line 19 is greater than Line 16, enter -0-)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. . __________________________.00
 21.     Use Tax for taxable items on which no sales tax was charged,                                                  Check to certify  
                                        including online purchases . (See instructions, worksheet, and chart)  . . .  X                    no Use Tax is due. OR        21.  __________________________1234567890               .00
                                                                                                                                                                                                                                                             FORM  (Place at LAST page)
 22.                                                         123456789012345Total Vermont Taxes (ADD Lines 20 and 21)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. . __________________________.00              Form pages 
  Nongame Wildlife Fund                    Vermont Children’s                        Vermont Veterans Fund                                Green Up Vermont                               Total Contributions
                                           Trust Foundation
23a.      __________12345         .00           +   23b. __________12345         .00           +   23c.  __________12345          .00           +   23d. __________12345           .00                 = 23e. __________12345   .00 

 24.                                                         123456789012345Total of Vermont Taxes and Voluntary Contributions (ADD Lines 22 and 23e)  . . . . . . . . . . . . . . . . . 24. . __________________________.00                                 19 - 20

                                          1234567890125a. 2023 Vermont Tax Withheld from W-2, 1099  . . . . . . . . . . . . . . . . . . .25a.  __________________       .00
  25b.   2023 Estimated Tax payments, amount carried forward from 2022,  
                                          12345678901and/or payment made with 2023 extension  . . . . . . . . . . . . . . . . . . . . . .25b.  __________________       .00
  25c.  Refundable Credits (Schedule IN-112, Part II:   
                                          12345678901Full-Year Residents-Line 8;Part-Year Residents-Line 12)  . . . . . . . 25c. .__________________                    .00

                                          12345678901  25d. 2023 Vermont Real Estate Withholding from Form RW-171  . . . . . . . 25d.  __________________               .00
  25e.   2023 Nonresident Estimated Tax payments 
                                          12345678901(nonresident withholding) allocated on Schedule K-1VT, Line 5  . . . . 25e. .__________________                    .00

                                                         123456789012345  25f. Total Payments and Credits (ADD Lines 25a through 25e)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25f.  __________________________.00

                                                         123456789012345 26. Overpayment .If Line 24 is less than Line 25f, SUBTRACT Line 24 from Line 25f  . . . . . . . . . . . 26. . __________________________.00

                                          12345678901  27a.  Refund to be credited to 2024 Estimated Tax Payment  . . . . . . . . . . . . 27a.  __________________      .00

                                          12345678901  27b. Refund to be credited to 2024 Property Tax Bill  . . . . . . . . . . . . . . . . . 27b.  __________________ .00

                                                         123456789012345 28. REFUND AMOUNT  (SUBTRACT Lines 27a and 27b from Line 26)  . . . . . . . . . . . . . . . . . . . . . . 28. . __________________________.00
 29.  If Line 24 is more than Line 25f, subtract Line 25f from Line 24. 
                                                         123456789012345See instructions on tax due  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .29.  __________________________.00
 30.  Interest and Penalty on                                                                              31.  AMOUNT DUE
                            Underpayment of Estimated Tax  . .30. _________________123456789                      .00  (ADD Lines 29 and 30)31.                            __________________________123456789012345            .00 
         (Worksheet IN-152 or IN-152A)

  For Amended           Original refund received                   Refund due now                                      Original payment                                      Amount due now
          Returns Only: 123456789012    .00                           123456789012   .00                                 123456789012    .00                                 123456789012                                       .00
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 
belief, they are true, correct and complete. Preparers cannot use return information for purposes other than preparing returns.

 Signature                                                                                               Date (MM/DD/YYYY)        Date of Birth (MM/DD/YYYY)                   Daytime Telephone Number
                                  MM DD YYYY  MM /       DD /                                                                                                           YYYY   123-123-1234
 Signature (If a joint return, BOTH must sign.)                                                          Date (MM/DD/YYYY)        Date of Birth (MM/DD/YYYY)                   Daytime Telephone Number
                                  MM DD YYYY  MM /       DD /                                                                                                           YYYY   123-123-1234
 Paid Preparer’s Signature                                                                                                        Date (MM/DD/YYYY)                            Preparer’s Telephone Number
                                              MM /       DD /                                                                                                           YYYY   123-123-1234
 Firm’s Name (or yours if self-employed) and address                                                                              Preparer’s SSN or PTIN                       FEIN
 123456789012345678901234567890123456          123456789      123456789
                                                                                                                                                                               Form IN-111
      X Check if the Department of Taxes may discuss this return with the preparer shown.                                        Keep a copy for                                         Page 2 of 2
                5454                                                                                                             your records.                                           Rev. 10/23