Schedule 4                     Schedule 4: Other Taxes                                                 Enclosure 
   Form IT-40, State Form 56540                                                                    Sequence No. 03B
   (R4 / 9-22)                                                                 2022

Name(s) shown on Form IT-40                                                    Your Social Security Number

1. Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet __________________   1        .00

2. Household employment taxes. Enclose Schedule IN-H __________________________________          2        .00

3. Recapture of certain Indiana offset credits. Enclose Schedule IN-CR _______________________   3        .00

4. Add lines 1 through 3. Enter here and on Form IT-40, line 10 ______________ Total Other Taxes 4        .00

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