Schedule F/ Schedule IN-DONATE         Schedule F: Credits                                                    Enclosure 
   Form IT-40PNR, State Form 54033                                                                         Sequence No. 05
   (R13 / 9-22)                                                                            2022

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

                                                                                                           Round all entries

1. Indiana state tax withheld: See instructions ___________________________________________             1                                     .00

2. Indiana county tax withheld: See instructions  _________________________________________             2                                     .00

3. Estimated tax paid for 2022: include any extension payment made with Form IT-9  ____________         3                                     .00

4. Unified tax credit for the elderly ____________________________________________________              4                                     .00
5. Earned income credit: see instructions
   Enter earned income credit from 
   Schedule IN-EIC, line A-3 _____________________________ Box A                      .00

   Enter number from Schedule A, Proration Section, line 21D ___ Box B           .

   Multiply Box A by Box B, enter total here ___________________________________________                5                                     .00

6. Lake County residential income tax credit ____________________________________________               6                                     .00

7. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,  
line 19 (enclose schedule) ________________________________________________________                     7                                     .00
8. Economic development for a growing economy retention credit. Enter amount from  
Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________                   8                                     .00

9. Headquarters relocation credit (refundable portion - see instructions)  ______________________         9                                   .00

10. Adoption Credit  ________________________________________________________________            10                                           .00

11. 2022 Additional Automatic Taxpayer Refund: See instructions ____________________________            11                                    .00

12. Add lines 1 through 11. Enter total here and on Form IT-40PNR, line 12 _________ Total Credits      12        .00

                                          Schedule IN-DONATE
                Important: The amount on line 2 cannot exceed the amount on Form IT-40/IT-40PNR, line 16.

1. Donations: List fund name, 3-digit code and amount to be donated (see instructions)

   a.  Enter fund name                                                 code no.                  1a                                           .00

   b.  Enter fund name                                                 code no.                  1b                                           .00

   c.  Enter fund name                                                 code no.                  1c                                           .00

2. Add lines 1a through 1c. Enter total here and on Form IT-40/IT-40PNR, line 17 Total Donations  2                                           .00

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