DEPT 
           Vermont Department of Taxes                                 USE                                                                                                        FILE YOUR RETURN 
                                                                       ONLY                                                                                                       ELECTRONICALLY FOR A 
                   2020 Form IN-111                                         *201111100*                                                                                           FASTER REFUND. GO TO  
                                                                                                                                                                                  TAX.VERMONT.GOV FOR 
          Vermont Income Tax Return                                         *201111100*                                                                                           MORE INFORMATION.
                                                              Please PRINT in BLUE or BLACK INK                                                                                                                       Page 17
 Taxpayer’s Last Name                               First Name                                   MI             Social Security Number
                                                                                                                                                                                                        Check if 
                                                                                                                                                                                                        Deceased
 Spouse’s/CU Partner’s Last Name                    First Name                                   MI             Social Security Number
                                                                                                                                                                                                        Check if 
                                                                                                                                                                                                        Deceased
 Mailing Address (Number and Street/Road or PO Box)                                              911/Physical Street Address on 12/31/2020

 City                                                   State    ZIP Code or Foreign Postal Code Foreign Country

 Vermont School District Code      Enter Healthcare Coverage Code           Check all                                                                                                                EXTENDED 
                                   (See instructions for code options)      that apply           AMENDED                                                                    RECOMPUTED               Return
                                                                                                 Return                                                                     Return
 Filing Status and        Single            Married/CU Filing Jointly       Married/CU Filing                        Head of Household                                                 Qualifying Widow(er) 
 Standard Deduction       ($6,250)          ($12,500)                       Separately ($6,250)                      ($9,400)                                                          ($12,500)

                                                                                                                 Check to                           
 1.  Federal Adjusted Gross Income (federal Form 1040, Line 11)  . . . . . . . . . . . . . . . . . . . .        ç indicate                          1. __________________________ .00
                                                                                                                 loss
                                                                                                                 Check to
 2.  Net Modifications to Federal AGI (Schedule IN-112, Part I, Line 15)  . . . . . . . . . . . . . .           ç indicate                          2. __________________________ .00
                                                                                                                 loss
                                                                                                                 Check to
 3.  Federal AGI with Modifications (Add Lines 1 and 2)  . . . . . . . . . . . . . . . . . . . . . . . . . . .  ç indicate                          3. __________________________ .00
                                                                                                                 loss

 4.  2020 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 can claim you as a dependent   . . . . . . . . . . . . . . . . . . . . . . . . .  . 5a.  _______
      5b.  Enter “1” for your jointly filed spouse or CU partner if no one can 
             claim them as a dependent or if you are a qualifying widow(er)  . . . . . . . . . . . . . . . . . . . . . . . .  . 5b.  _______
      5c.  Enter number of other dependents claimed on federal Form 1040 .  
           This includes any dependents other than yourself and/or your spouse .  . . . . . . . . . . . . . . . . . . . . 5c.  _______

      5d.  Add Lines 5a through 5c  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5d.   ________

 5e.  Multiply Line 5d by $4,350 (2020 Personal Exemption)  . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  . 5e.  __________________________ .00

 6.  Add Lines 4 and 5e  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 6.  __________________________ .00

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

 8.  Vermont Income Tax from tax table or tax rate schedule   . . . . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  .  .  .  .  .  .  . 8.  __________________________ .00
     (If Line 1 is greater than $150,000, see instructions)
                                                                                                                 Check to                           
 9.  Net Adjustment to Vermont Tax (Schedule IN-119, Part I, Line 16)  . . . . . . . . . . . . . . . .          ç indicate                          9. __________________________ .00
                                                                                                                 loss

 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         13. __________________________                                                          .00
                          ___________ .00               ___________ .00                of Line 12 or $1,000)   . . . . .  .  

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.  _______ . _________%

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

           Amount Due                                                                                                                                                             Form IN-111
           (from Line 31)                           0 .00              Page 1 of 2               5454                                                                                  Rev . 10/20

           Taxpayer’s Last Name                          Social Security Number

                                                                                                     *201111200*
                                                                                                     *201111200*
                                                                                                                                                                                                      Page 18
       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. _____________________         .00               +   18. ____________________ .00                            =                 19. __________________________ .00
20.    Vermont Income Tax after credits  (Subtract Line 19 from Line 16 . 
       If 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)  . . .            no Use Tax is due .  OR             21. __________________________ .00

22.    Total Vermont Taxes (Add Lines 20 and 21)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 22. __________________________ .00
 Children’s Trust Fund             Vermont Veterans Fund       Green Up Vermont                      Nongame Wildlife Fund                                         Total Contributions
23a.   _________.00             +  23b. _________    .00 +     23c.  _________.00                  + 23d. _________.00                     =                   23e. ___________  .00

24.    Total of Vermont Taxes and Voluntary Contributions (Add Lines 22 and 23e)  . . . . . . . . . . . . . . . . . .  . 24. __________________________ .00

25a.   2020 Vermont Tax Withheld from W-2, 1099  . . . . . . . . . . . . . . . . . . .       25a.  __________________ .00
  25b. 2020 Estimated Tax payments, amount carried forward from 2019, 
       and payment made with 2020 extension  . . . . . . . . . . . . . . . . . . . . . . . . 25b.  __________________ .00

  25c.  Refundable Credits (Schedule IN-112, Part II)  . . . . . . . . . . . . . . . . . . .  .25c.  __________________ .00

  25d. 2020 Vermont Real Estate Withholding from Form RW-171  . . . . . . . 25d.  __________________ .00
  25e. 2020 Nonresident Estimated Tax payments 
       (nonresident withholding) allocated on Schedule K-1VT, Line 5  . . . .  .25e.  __________________ .00
  25f. Total Payments and Credits (Add Lines 25a through 25e)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25f.  __________________________ .00

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

  27a.  Refund to be credited to 2021 Estimated Tax Payment  . . . . . . . . . . . .         27a.  __________________ .00

  27b. Refund to be credited to 2021 Property Tax Bill  . . . . . . . . . . . . . . . . . 27b.  __________________ .00

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 . 
       See instructions on tax due  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . 29. __________________________ .00
 30.   Interest and Penalty on                                                                 31. AMOUNT DUE
       Underpayment of Estimated Tax  . . 30. _________________.00                             (Add Lines 29 and 30)  . 31.  __________________________ .00
       (Worksheet IN-152 or IN-152A)

 For Amended    Original refund received                 Refund due now                            Original payment                                            Amount due now
 Returns Only:                                       .00                                       .00                                                         .00                            .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

                                                                                                                 /        /
 Signature (If a joint return, BOTH must sign .)                        Date (MM/DD/YYYY)            Date of Birth (MM/DD/YYYY)                                Daytime Telephone Number

                                                                                                                 /        /
 Paid Preparer’s Signature                                                                           Date                                                      Preparer’s Telephone Number

                                                                                                                 /        /
 Firm’s Name (or yours if self-employed) and address                                                 Preparer’s SSN or PTIN                                    FEIN

           Check if the Department of Taxes may discuss this return with the preparer shown .        Keep a copy for                                           Form IN-111
           5454                                                         Page 2 of 2                  your records.                                                 Rev . 10/20

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