VT Form IN-110 "Change of Name and/or Address for Personal Income and/or Renter Rebate Claim" - Vermont

What Is VT Form IN-110?

This is a legal form that was released by the Vermont Department of Taxes - a government authority operating within Vermont. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2020;
  • The latest edition provided by the Vermont Department of Taxes;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of VT Form IN-110 by clicking the link below or browse more documents and templates provided by the Vermont Department of Taxes.

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Download VT Form IN-110 "Change of Name and/or Address for Personal Income and/or Renter Rebate Claim" - Vermont

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Vermont Department of Taxes
PO Box 1645
Montpelier, VT 05601-1645
Phone: (802) 828-2865
VT Form
CHANGE OF NAME and/or ADDRESS
IN-110
for Personal Income and/or Renter Rebate Claim
Prior Name and Address
Individual Last Name
First Name
MI
Social Security Number
Spouse/CU Partner Last Name
First Name
MI
Spouse/CU Partner Social Security Number
Mailing Address
Telephone Number
City
State
ZIP Code
Foreign Country (if not United States)
Current Name and Address
Individual Last Name
First Name
MI
Social Security Number
Spouse/CU Partner Last Name
First Name
MI
Spouse/CU Partner Social Security Number
Mailing Address
Telephone Number
City
State
ZIP Code
Foreign Country (if not United States)
Email Address
EXPLANATION OF CHANGE: ________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Are you picking up a refund check? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
Are you currently expecting a refund check? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
SUPPORTING DOCUMENTS
Send a copy of:
• One valid photo ID, and
• One other form of ID, and
• Other document(s), if applicable
SIGNATURE(S) - REQUIRED
Signature of Taxpayer
Date
Signature of Spouse/CU Partner. If filed jointly, BOTH taxpayers must sign.
Date
Mail completed request, with supporting documents, to:
Vermont Department of Taxes
PO Box 1645
Montpelier, VT 05601-1645
For Department Use Only
Form IN-110
Check Number
Date Picked Up
Processed by
Page 1 of 1
5454
Rev. 03/20
Clear ALL fields
Save and go to Important Printing Instructions
Save and Print
Vermont Department of Taxes
PO Box 1645
Montpelier, VT 05601-1645
Phone: (802) 828-2865
VT Form
CHANGE OF NAME and/or ADDRESS
IN-110
for Personal Income and/or Renter Rebate Claim
Prior Name and Address
Individual Last Name
First Name
MI
Social Security Number
Spouse/CU Partner Last Name
First Name
MI
Spouse/CU Partner Social Security Number
Mailing Address
Telephone Number
City
State
ZIP Code
Foreign Country (if not United States)
Current Name and Address
Individual Last Name
First Name
MI
Social Security Number
Spouse/CU Partner Last Name
First Name
MI
Spouse/CU Partner Social Security Number
Mailing Address
Telephone Number
City
State
ZIP Code
Foreign Country (if not United States)
Email Address
EXPLANATION OF CHANGE: ________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Are you picking up a refund check? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
Are you currently expecting a refund check? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
SUPPORTING DOCUMENTS
Send a copy of:
• One valid photo ID, and
• One other form of ID, and
• Other document(s), if applicable
SIGNATURE(S) - REQUIRED
Signature of Taxpayer
Date
Signature of Spouse/CU Partner. If filed jointly, BOTH taxpayers must sign.
Date
Mail completed request, with supporting documents, to:
Vermont Department of Taxes
PO Box 1645
Montpelier, VT 05601-1645
For Department Use Only
Form IN-110
Check Number
Date Picked Up
Processed by
Page 1 of 1
5454
Rev. 03/20
Clear ALL fields
Save and go to Important Printing Instructions
Save and Print