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Schedule LIC                              Indiana Department of Revenue
State Form 21926
(R15 / 8-20)                                  Enterprise Zone
                                          Loan Interest Tax Credit
                                     For Tax Year Ending:  Month_________ Year _______                  Enclosure Sequence No. 28
(Enclose completed schedule with annual state tax liability return.) 
 Section A - Taxpayer Information
 Name of Taxpayer (lender)                                                         Social Security Number or FEIN

 Street Address                                                                    County

 City or Town, State, and ZIP Code                                                 Taxpayer’s Telephone Number

 Section B - Qualified Loan Information  (attach list of all borrowers) Section B continued on reverse side.
 Name of Borrower (A)                                                              Borrower’s Social Security Number or FEIN

 Street Address                                                                    Borrower’s Telephone Number

 City or Town, State, and ZIP Code

 Use of Loan (check one):                Date of Loan Origination:                 Location Name of Borrower’s Enterprise Zone
 □ Business    □ Personal
 Section C - Report of Qualified Loans to Businesses by Enterprise Zone Locations 
 Summarize the number of qualified loans to businesses in each enterprise zone and the amount of interest received during the taxable year.
 Enterprise Zone       (a)                (b)                        Enterprise Zone         (C)                                          (d)
                   Number of           Interest Income                                       Number of                                    Interest Income
                       Loans                                                                 Loans
 Bedford                           $                   00            Lafayette                                                        $                  00
 Bloomington                       $                   00            La Porte                                                         $                  00
 Connersville                      $                   00            Michigan City                                                    $                  00
 East Chicago                      $                   00            Mitchell                                                         $                  00
 Elkhart                           $                   00            New Albany                                                       $                  00
 Evansville                        $                   00            Portage                                                          $                  00
 Ft. Harrison                      $                   00            Richmond                                                         $                  00
 Ft. Wayne                         $                   00            River Ridge                                                      $                  00
 Frankfort                         $                   00            Salem                                                            $                  00
 Hammond                           $                   00            South Bend                                                       $                  00
 Jeffersonville                    $                   00            Vincennes                                                        $                  00
 Subtotal                          $                   00            Subtotal                                                         $                  00
 Section D - Credit for Qualified Loans for the Taxable Year
 1. Grand total of all qualified loans to businesses listed in Section C, columns (a) and (c) ....................                    1 $                00
 2. Total amount of loan interest income received from qualified loans in Section C, columns (b) and (d) .                            2 $                00
 3. Amount of loan interest income received from other qualified nonbusiness loans made for home 
 improvements within all enterprise zones ........................................................................................... 3 $                00
 4. Total Loan Interest Credit - add amounts on lines 2 and 3; multiply result by 5 percent (.05) ............                        4 $                00
 5. Indicate for which tax type you are applying this credit. Enter net amount of tax you are offsetting: 
 a □ Adjusted Gross Income Tax         b □ Insurance Premium Tax or Nonprofit Agricultural                                            5 $                00
 Organization Health Coverage Tax      c□ Financial Institutions Tax 
 The tax offset may not exceed the amount of available credit from line 4.  
 Carry amount on line 5 to other credit line of your return.

 6. Unused amount of credit available for carryover - subtract line 5 from line 4 and complete Section E ..                           6 $                00
                                         *24100000000*
                                                       24100000000

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Section B - Qualified Loan Information Continued  (Attach additional sheets if necessary.)
Name of Borrower (B)                                             Borrower’s Social Security Number or FEIN

Street Address                                                   Borrower’s Telephone Number

City or Town, State, and ZIP Code

Use of Loan (Business or         Date of Loan Origination        Location Name of Borrower’s Enterprise Zone
Personal)

Name of Borrower (C)                                             Borrower’s Social Security Number or FEIN

Street Address                                                   Borrower’s Telephone Number

City or Town, State, and ZIP Code

Use of Loan (Business or         Date of Loan Origination        Location Name of Borrower’s Enterprise Zone
Personal)

Name of Borrower (C)                                             Borrower’s Social Security Number or FEIN

Street Address                                                   Borrower’s Telephone Number

City or Town, State, and ZIP Code

Use of Loan (Business or         Date of Loan Origination        Location Name of Borrower’s Enterprise Zone
Personal)

Section E - Enterprise Zone Interest Credit Carryover (814)
                      Enter the initial tax period in which the Enterprise Zone Loan Interest Credit was claimed.
                            Enter the remaining unused amount of credit from Section D, line 6.
Initial Tax Year Ending:                          Enterprise Zone Loan Interest Credit Available 
Month ________________   Year_________            for Carryforward from Section D, Line 6:    $_______________________
                                 Show how the unused credit is applied during the carryover period.
                            Unused Credit (column (5)) is to be placed on your return for the next tax year.
               (1)                                (2)            (3)                               (4)           (5)
                                       Total               Type of Tax
         Credit Carryforward           Amount of Tax       Liability Reduced Amount Applied                      Unused Credit
1st Following Tax Year    __________
2nd Following Tax Year   __________
3rd Following Tax Year    __________
4th Following Tax Year    __________
5th Following Tax Year    __________
6th Following Tax Year    __________
7th Following Tax Year    __________
8th Following Tax Year    __________
9th Following Tax Year    __________
10th Following Tax Year  __________
Section F - Signature

I certify I have examined this schedule and, to the best of my knowledge and belief, the information contained in this schedule is true, 
correct, and complete.
Signature of Taxpayer: ____________________________       Title _____________________              Date Signed: _________________

                                    *24100000000*
                                                      24100000000

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Instructions for Completing Schedule LIC

Indiana Code (IC) 6-3.1-7-2 provides that a taxpayer who is
Section B - Qualified Loan Information
in good standing with the Indiana Economic Development
Corporation is entitled to a state income tax credit of 5% Enter the following information for each qualified loan,
of the interest income received from qualified loans made or provide a combined listing of borrowers within every
before January 1, 2018. To qualify, the loan proceeds must enterprise zone. Attach additional sheets as necessary:
be for purposes directly related to businesses located in
an enterprise zone or for improvements increasing the 1) Enter the borrower’s name and location address
assessed value of real property located in an enterprise within the enterprise zone.
zone.* A qualified loan also means a loan made to an 2) Enter the borrower’s Social Security Number or
individual or business that uses the loan proceeds toward Federal Employer Identification Number.
the rehabilitation, repair, or improvement of a residence 3) Enter the borrower’s telephone number.
within an enterprise zone. 4) Indicate the purpose of the loan (business or
personal home improvement) and the date of loan
*An enterprise zone created under IC 5-28-15 or an air- origination.
port development zone (code # 802) designated under 5) Enter the name of the borrower’s enterprise zone
IC 8-22-3.5-14. location.

Section C – Report of Qualified Loans to Businesses
Who May File for This Credit?
by Enterprise Zone Locations
For the purposes of eligibility, for the Loan Interest Credit,
a taxpayer in good standing is defined as an entity Summarize the number of qualified loans on which you
conducting business operations within an enterprise zone received interest during the taxable year according to the
that: enterprise zone in which the loan proceeds are used by the
1) Receives interest on a qualified loan made during business borrower(s) (listed in Section B).
the tax year;
2) Pays the registration fee charged to zone Enter the total amount of interest income received
businesses under IC 5-28-15-5; from qualified loans to businesses during the taxable
3) Provides the assistance to urban enterprise year attributed to the enterprise zone location of the
associations required from zone businesses under borrower(s), columns (a) and (c).
IC 5-28-15-5(b); and
4) Complies with any requirements adopted by the For purposes of the Loan Interest Credit, interest includes
board of the Indiana Economic Development service charges, time-price differentials, and all other
Corporation for taxpayers claiming the Enterprise charges for the use of money. Interest received from
Zone Loan Interest Credit. loans and lines of credit existing at the time an enterprise
zone was designated qualify for the credit if the proceeds
Note: If the taxpayer is located outside an enterprise zone, are used for a qualified purpose. Interest from mortgage
the taxpayer is not required to reinvest its incentives within loans to acquire property does not qualify unless the
the enterprise zone, other than complying with 2) and 3) property is used for business purposes (including renting
above. or leasing). If the proceeds of a loan are used to both
acquire and improve real property and the acquisition is
How Often Can I Claim a Credit? not for a business purpose, only that portion of the interest
attributable to the improvement of the property would
A claim for credit is filed annually for each qualified loan qualify for the Loan Interest Credit. If the loan proceeds are
or in combination with all qualified loans made during the used to acquire business property which is subsequently
taxable year. removed from an enterprise zone, only the interest received
while the property was used for a business purpose within
Section A - Taxpayer Information the enterprise zone would qualify for the credit.

1) Type or print lender’s name and address. Section D – Credit for Qualified Loans for
2) Enter lender’s Social Security Number or Federal the Taxable Year
Employer Identification Number.
3) Enter Indiana county or O.O.S. (out-of-state). Line 1. Enter the grand total of all qualified loans to
4) Enter telephone number. businesses listed in Section C, columns (a) and (c).

Line 2. Enter the amount of loan interest income received
from businesses during the taxable year from qualified
loans listed in Section C, columns (b) and (d).

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Line 3. Enter the total other loan interest income received Refer to Income Tax Information Bulletin #66 at
from nonbusiness loans made for the purposes of www.in.gov/dor/legal-resources/tax-library/information-
rehabilitation, repair, or improvement of a residence or for bulletins/income-tax-information-bulletins for additional
improvements that increase the assessed value of real information. Please see the instructions for your tax return
property located in any enterprise zone. to determine where the credit should be entered on the
various tax forms.
Line 4. Add the amount of business and nonbusiness
interest income and multiply the result by 5%. What if I Do Not Use All of My Credit?
Any unused credit may be carried over to the next eligible
Line 5. Indicate the state tax liability you wish to offset by
tax return to be filed up to 10 years from the date of the
checking the appropriate tax type box and by entering the
loan until all credit has been used or the enterprise zone
net amount of your state tax liability. Note: The net amount
terminates.
of tax entered on line 5 must be reduced by all other
applicable tax liability credits and may not be greater than
Note: A taxpayer is not entitled to a carryback or refund of
the amount on line 4. Carry the net amount of credit to be
any unused credit. The statute does allow the taxpayer to
used to your tax type return.
carry forward any unused credit.
Line 6. Subtract line 5 from line 4. The result may not be
less than zero. If it’s greater than zero, carry the excess What if I Am an Entity Exempt from
unused amount of credit to Section E. Adjusted Gross Income Tax?
Entities exempt from adjusted gross income tax under
Section E – Enterprise Zone Loan Interest Carryover IC 6-3-2-2.8(2) may “pass through” the credit to
Complete this section whenever there is a carryover shareholders, partners, beneficiaries, or members of
of unused Loan Interest Credit. The amount of credit the pass-through entity. A pass-through entity is an
carryover from a taxable year shall be reduced to the extent S corporation, a partnership, a trust, a limited liability
that the carryover is used by the taxpayer to obtain credit company, or a limited liability partnership. Each member’s
against allowable state tax liabilities for any subsequent tax credit is calculated by multiplying the total credit
taxable year. Carryover is allowed up to 10 years following available by the percentage of the entity’s distributive
the date on which a qualified loan credit is claimed but not income to which the shareholder, partner, beneficiary, or
beyond the phase-out period that terminates the enterprise member is entitled. The pro rata share of the calculated
zone from which a qualified loan had originated. credit is reported by the entity on each unit-holder’s
Schedule IN K-1. A copy of Schedule LIC or IN K-1 must be
Enter in each column the applicable date or amounts for enclosed with the return to claim your share of the credit.
every succeeding taxable year in which a credit carryover
is used. Whom Do I Contact if I Have Questions
About the Enterprise Zone Loan Interest Credit?
Section F – Signature Questions concerning enterprise zone income tax
The taxpayer or an authorized agent must sign this provisions should be directed to:
schedule.
Indiana Department of Revenue
Returns Processing Center
Where Can I Claim This Credit?
Corporate Income Tax Section
The Loan Interest Credit can be applied as a credit against P.O. Box 7206
the taxpayer’s adjusted gross income tax (IC 6-3-1 through Indianapolis, IN 46207
6-3-7), insurance premium tax (IC 27-1-18-2) or nonprofit (317) 232-0129
agricultural organization health coverage tax (IC 6-8-15), www.in.gov/dor
and financial institution tax (IC 6-5.5). A copy of Schedule
LIC must be enclosed with the return; otherwise, the credit For questions concerning other provisions related
will be disallowed. The credit amount calculated on the to enterprise zones and current locations within the
LIC is to be taken as a credit against your tax liability on designated cities, contact:
the return in the order listed above after first applying other
credits allowed under IC 6-3.1-1-2. Use 3-digit code 814 to Indiana Economic Development Corporation
identify this credit where applicable. 1 N. Capitol Ave., Suite 700
Indianapolis, IN 46204
(317) 232-8800
www.iedc.in.gov

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