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Schedule A Schedule A Section 1: Income or Loss Enclosure
Form IT-40PNR (Complete Proration, Section 2 and Section 3 on back) Sequence No. 01
State Form 48719 2022
(R21 / 9-22) Page 1 of 2
Name(s) shown on Form IT-40PNR Your Social Security Number
Section 1: Income or (Loss) Enter in Column A the same income or loss you reported on your 2022 federal income tax return, Form
1040, Form 1040-SR, and Form 1040 Schedule 1 (except for line 19B and/or a net operating loss carryforward on line 20B; see
instructions). Round all entries.
Column A Column B
Income from Federal Return Income Taxed by Indiana
1. Your wages, salaries, tips, commissions, etc _____________ 1A .00 1B .00
2. Spouse’s wages, salaries, tips, commissions, etc _________ 2A .00 2B .00
3. Taxable interest income _____________________________ 3A .00 3B .00
4. Dividend income __________________________________ 4A .00 4B .00
5. Taxable refunds, credits, or offsets of state
and local taxes from your federal return ________________ 5A .00 5B .00
6. Alimony received __________________________________ 6A .00 6B .00
7. Business income or loss from federal Schedule C ________ 7A .00 7B .00
8. Capital gain or loss from sale or exchange
of property from your federal return ____________________ 8A .00 8B .00
9. Other gains or (losses) from Form 4797 ________________ 9A .00 9B .00
10. Taxable IRA distribution _____________________________ 10A .00 10B .00
11. Taxable pensions and annuities _______________________ 11A .00 11B .00
12. Net rent or royalty income or loss reported on
federal Schedule E ________________________________ 12A .00 12B .00
13. Income or loss from partnerships _____________________ 13A .00 13B .00
14. Income or loss from trusts and estates _________________ 14A .00 14B .00
15. Income or loss from S corporations ____________________ 15A .00 15B .00
16. Farm income or loss from federal Schedule F ____________ 16A .00 16B .00
17. Unemployment compensation ________________________ 17A .00 17B .00
18. Taxable Social Security benefits _______________________ 18A . 00 18B .00
19. Indiana apportioned income from
Schedule IT-40PNRA ___________________________________________________________ 19B .00
20. Other income reported on your federal return ____________ 20A .00 20B .00
List source(s). (Do not include federal net operating loss in Column B. See instructions.)
21. Subtotal: add lines 1 through 20 _______________________ 21A .00 21B .00
*23422111694*
23422111694
