Schedule K-1VT (2025) — Vermont Shareholder, Partner, or Member Information

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Vermont Shareholder, Partner, or
Member Information
25K1V1100

• 2 5 K 1 V 1 1 0 0 *

This schedule is REQUIRED.
Include with Form BI-471
Fiscal Year Ending (YYYYMMDD) FEIN

# HEADER INFORMATION - REQUIRED ENTRIES

Entity Name (Shareholder, Partner, or Member)
OR
Individual Last Name (Shareholder, Partner, or Member) First Name
Address
Address, Line 2 (if needed)
City State
Foreign Country (if not United States)

PART I PASS-THROUGH ENTITY INFORMATION
FEIN
OR
Initial Social Security Number
Recipient Type
(I, C, S, L, P, X, or T)

Residency Status

# Vermont Nonresident

ZIP Code
Resident
Special Allocations (see instructions)

1. Capital / Ownership percentage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. _ . _%
2. Profit percentage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. _ . _%
3. Loss percentage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. _ . _%
4. Distributive share percentage (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. _ . _% Yes No
5. Disregarded entity (single-member LLC or Qualified Subchapter S subsidiary)? . . . . . 5. Provide FEIN or SSN __

Yes No

1. Is this partner a member of a complex structure (see instructions)?. . . . . . . . . . . . . . . . 6.

Yes No

1. Did this entity pay tax on this income as part of a composite return?. . . . . . . . . . . . . . . 7.

PART II DISTRIBUTIVE SHARE OF VERMONT ADJUSTMENTS Enter all amounts in whole dollars.
A. Everywhere
8a. Bonus depreciation adjustment

B. Vermont
(apportionable items). . . . . . . . . . . . . . . 8aA. _ __ .00
8b. Bonus depreciation adjustment

8aB. __.00
(non-apportionable items). .. . . . . . . . . . 8bA. _ __ .00

1. Other Additions

8bB. __.00
(include statement). . . . . . . . . . . . . . . . . . 9A. _ __ .00

1. Other Subtractions

9B. __.00
(include statement). . . . . . . . . . . . . . . . . 10A. _ __ .00
10B. __.00

FEIN Fiscal Year Ending (YYYYMMDD)
FOR TRUST, CORPORATE, AND PASS-THROUGH PARTNERS ONLY:
11a. SALT Add-back (apportionable items). . . . . . . . . . . . . . 11aA. _ __ .00
11b. SALT Add-back (non-apportionable items). .. . . . . . . . . 11bA. _ __ .00

# PART III DISTRIBUTIVE SHARE OF VERMONT SOURCE INCOME

A. Everywhere

1. Ordinary business income (loss). . . . . . . 12A. _ __ .00
2. Net rental real estate income (loss). . . . . 13A. _ __ .00
3. Other net rental income (loss) . . . . . . . . 14A. _ _ .00 15a. Guaranteed payments for services. . . . 15aA. _ .00 15b. Guaranteed payments for capital. . . . . 15bA. _ _ .00
4. Interest income. . . . . . . . . . . . . . . . . . . . 16A. _ __ .00
5. Ordinary dividends. . . . . . . . . . . . . . . . . 17A. _ __ .00
6. Royalties. . . . . . . . . . . . . . . . . . . . . . . . . 18A. _ __ .00
7. Net short-term capital gain (loss). . . . . . 19A. _ __ .00
8. Net long-term capital gain (loss) . . . . . . 20A. _ __ .00
9. Net I. R. C. § 1231 gain (loss). . . . . . . . . 21A. _ __ .00
10. Other income (loss) (include statement). 22A. _ __ .00
11. I. R. C. § 179 expense deduction. . . . . . . 23A. _ __ .00
12. Other expense deductions (include statement). . . . . . . . . . . . . . . . . 24A. _ __ .00
13. Recharacterized income to/from

Schedule BI-477, Part III. . . . . . . . . . . . 25A. _ __ .00

1. Recharacterized income to/from

Schedule BI-477, Part I . . . . . . . . . . . . . 26A. _ __ .00

1. Total distributive share (see instructions). . . . . . . . . . . . . . . . . . . 27A. _ __ .00 25K1V1200

11aB. __.00
11bB. __.00
B. Vermont
12B. __.00
13B. __.00
14B. __.00
15aB. __.00
15bB. __.00
16B. __.00
17B. __.00
18B. __.00
19B. __.00
20B. __.00
21B. __.00
22B. __.00
23B. __.00
24B. __.00
25B. __.00
26B. __.00
27B. __.00

25K1V1300

• 2 5 K 1 V 1 3 0 0 *

FEIN Fiscal Year Ending (YYYYMMDD)

# PART IV OTHER DISTRIBUTIONS TO OWNERS

1. Exempt income - Vermont income not characterized as Unrelated

Business Income (UBI) for federal purposes (tax-exempt entities only). . . . . . . . . . . 28. __.00

1. Vermont income tax withheld on behalf of owner. . . . . . . . . . . . . . . . . . . . . . . . . . . . 29. __.00
2. Vermont income tax withheld by a lower-tier pass-through entity. . . . . . . . . . . . . . . 30. __.00
3. Total Vermont annual real estate withholding payments withheld on behalf of owner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31. __.00
4. Total Vermont composite income tax paid on behalf of owner. . . . . . . . . . . . . . . . . . 32. __.00
5. Capital gain eligible for exclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33. __.00 PART V OWNER'S DISTRIBUTIVE SHARE OF VERMONT SALES AND RECEIPTS FACTOR (CORPORATE AND PASS-THROUGH ENTITY OWNERS)

A. Everywhere B. Vermont

1. Total gross receipts. . . . . . . . . . . . . . . . . 34A. _ _ .00 34B. _.00 PART VI REPORTING OWNER'S DISTRIBUTIVE SHARE OF OTHER APPORTIONMENT FACTORS (CORPORATE AND PASS-THROUGH ENTITY OWNERS)

A. Everywhere B. Vermont

1. Payroll. . . . . . . . . . . . . . . . . . . . . . . . . . . 35A. _ _ .00 35B. _.00
2. Property . . . . . . . . . . . . . . . . . . . . . . . . . 36A. _ _ .00 36B. _.00 PART VII COMPLEX STRUCTURES: DISTRIBUTIVE SHARE OF SEPARATE SOURCE INCOME AND ADJUSTMENTS FROM

LOWER-TIER PASS-THROUGHS WITH NO UNITARY RELATIONSHIP
A. Everywhere B. Vermont

1. Lower-Tier Separate Source

Income (see instructions). . . . . . . . . . . . 37A. _ _ .00 37B. _.00

1. Vermont Adjustments for Separate

Source Income (see instructions). . . . . . 38A. _ _ .00 38B. _.00

# PART VIII OTHER INFORMATION PROVIDED BY PASS-THROUGH

1. Additional Information __
   1. Additional Information __
   2. Additional Information __
   3. Additional Information __
   4. Additional Information __

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