INCLUDE WITH FORM IN-111 Please PRINT in BLUE or BLACK INK Schedule IN-119 Page 1 of 2 Rev. 10/21 Vermont Department of Taxes 2021 Schedule IN-119 Vermont Tax Adjustments and Nonrefundable Credits *211191100* * 2 1 1 1 9 1 1 0 0 *

Taxpayer’s Last Name First Name MI Taxpayer’s Social Security Number 5454 PART I ADJUSTMENTS TO VERMONT INCOME TAX ADDITIONS TO VERMONT TAX 1. Tax on Qualified Plans including IRA, HSA, and MSA (reported on federal Form 1040, U.S. Individual Income Tax Return). . . . . 1. _____________________________ .00 2. Recapture of Federal Investment Tax Credit (reported on Form 1040). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. _____________________________ .00 3. Tax from federal Form 4972, Tax on Lump-Sum Distributions . . 3. _____________________________ .00 4. ADD Lines 1 through 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. _____________________________ .00 5. MULTIPLY Line 4 by 24% (0.24) . . . . . . . . . . . . . . . . . . . . . . . 5. _____________________________ .00 6. Recapture of Vermont Credits (See instructions). . . . . . . . . . . . . . 6. _____________________________ .00 7. ADD Lines 5 and 6.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. _ ___________________________.00 SUBTRACTIONS FROM VERMONT TAX 8. Credit for Child & Dependent Care Expenses (reported on Form 1040). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. _____________________________ .00 9. Credit for the Elderly or the Disabled (federal Schedule R). . . . . . 9. _____________________________ .00 10. Investment Tax Credit - Vermont-based only (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. _____________________________ .00 11. Vermont Farm Income Averaging Credit (from worksheet in instructions). . . . . . . . . . . . . . . . . . . . . . . . . . 11. _____________________________ .00 12. ADD Lines 8 through 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. _____________________________ .00 13. MULTIPLY Line 12 by 24% (0.24) . . . . . . . . . . . . . . . . . . . . . 13. _____________________________ .00 14. Vermont-based Solar Energy Credit carryforward. . . . . . . . . . . . 14. _____________________________ .00 15. ADD Lines 13 and 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15. _ ___________________________.00 NET ADJUSTMENTS TO VERMONT TAX 16. SUBTRACT Line 15 from Line 7. Enter on Form IN-111, Vermont Income Tax Return, Line 9. This can be a negative number.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16. _ ___________________________.00

PART II VERMONT INCOME TAX CREDITS 1. Vermont Higher Education Investment (32 V.S.A § 5825a) See instructions. . . . . . . . . . . . . . . . . . . . ________________.00

________________.00 INCLUDE WITH FORM IN-111 2021 Contribution eligible for credit Credit TIMES (X) .10 = For credits earned through an S-Corporation, LLC, or Partnership, enter name and FEIN of the entity If credits from more than one business entity, fill out a separate IN-119 for each entity. Column A Earned in 2021 Column B Carryforward Column C PLUS (+) EQUALS (=) Schedule IN-119 Page 2 of 2 Rev. 10/21

Name of Entity FEIN *211191200* * 2 1 1 1 9 1 2 0 0 *

Taxpayer’s Last Name Social Security Number 5454 2. Charitable Housing (32 V.S.A. § 5830c). . . . . . . . . . . . . 2A. ________________.00 2B. ________________.00 2C. ________________.00 3. Qualified Sale of Mobile Home Park (32 V.S.A. § 5828). . . . . . . . . . . . . . 3A. ________________.00 3B. ________________.00 3C. ________________.00 4. Research & Development (32 V.S.A. § 5930ii). . . . . . . . . . . . . 4A. ________________.00 4B. ________________.00 4C. ________________.00 Prior approval required from Vermont Housing Finance Agency for Line 5 5. Affordable Housing (32 V.S.A § 5930u). . . . . . . . . . . . . . 5A. ________________.00 5B. ________________.00 5C. ________________.00 6. Historic Rehabilitation (32 V.S.A. § 5930cc(a)) . . . . . . . . . . 6A. ________________.00 6B. ________________.00 6C. ________________.00 7. Facade Improvement (32 V.S.A. § 5930cc(b)). . . . . . . . . . 7A. ________________.00 7B. ________________.00 7C. ________________.00 8. Code Improvements (32 V.S.A. § 5930cc(c)). . . . . . . . . . 8A. ________________.00 8B. ________________.00 8C. ________________.00 9. ADD Column C, Lines 1 through 8. If no credit claimed on Line 10, enter this amount on Form IN-111, Line 18 . . 9. ________________.00 Tax Credit Calculation Worksheet 10. Vermont Entrepreneur’s Seed Capital Fund (32 V.S.A. § 5830b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10. ________________.00 11. Enter adjusted Vermont income tax amount from Form IN-111, Line 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. ________________.00 12. Enter credit for income tax paid to another state or Canadian province from Form IN-111, Line 17 . . . . . . . . . . . . . . .12. ________________.00 13. SUBTRACT Line 12 from Line 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13. ________________.00 14. Enter the lesser of Line 9 or Line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14. ________________.00 15. SUBTRACT Line 14 from Line 13. The result cannot be less than zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15. ________________.00 16. MULTIPLY Line 15 by 50% (0.50). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16. ________________.00 17. Enter the lesser of Line 10 or Line 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17. ________________.00 18. Total Credits Allowable. ADD Lines 14 and 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18. ________________.00 19. Total Income Tax Credits Available. Enter the lesser of Line 13 or Line 18. Enter this amount on Form IN-111, Line 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19. ________________.00 Clear ALL fields Save and go to Important Printing Instructions Save and Print