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Form                                          Indiana Department of Revenue                     Due April 18, 2023
IT-9              2022        Application for Extension of Time to File 
State Form 21006
(R22 / 9-22)

Your Social                                                Spouse’s Social 
Security Number                                            Security Number

Your first name                                    Initial Last name

If filing a joint return, spouse’s first name      Initial Last name

Present address (number and street or rural route) 

City                                                          State                 ZIP/Postal code

•  Complete Part 1 if you are making an extension payment.
•  Complete Part 2 if you are not making an extension payment.

Part 1: Payment Information

Complete the worksheet on the back of this form to figure the amount to pay.

1. State tax due from line J of worksheet  ________________________________________State Tax    1                         .00

2. From line K of worksheet: 
a. Enter your county code ____________________________________
b. Enter county tax ______________________________________________          Your County Tax     2b                        .00

3. From line L  of worksheet: 
a. Enter spouse’s county code (if different from yours) ______________
b. Enter spouse’s county tax __________________________________             Spouse’s County Tax 3b                        .00

4. Add lines 1, 2b and 3b ____________________________________________ Extension Payment        4                         .00
•  Please make your check or money order payable to: Indiana Department of Revenue. 
See instructions for other payment options.

Part 2: Nonpayment Information

1. Place an “X” in the box if you are not intending to make a payment with this form __________________________ No Payment

Do not attach Form IT-9 to your tax return when filing.

                              Mail entire form with any payment due by April 18, 2023, to:
                                              Indiana Department of Revenue
                                                       P.O. Box 6117
                                              Indianapolis, IN 46206-6117

                              *01222111694*
                                                       01222111694



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                         Form IT-9: Application for Extension of Time to File Instructions
Who should get an extension of time to          portal,the Indiana Taxpayer Information                 Payments must be made with U.S. funds. 
file? You must get an extension of time to      Management Engine (INTIME), at intime.
file if you are required to file a 2022 Indiana dor.in.gov. Making a payment online will be             Pay online. To make an electronic payment, 
individual income tax return, but cannot file   considered to be filing for an extension, and           visit DOR’s e-services portal,the Indiana 
by the April 18, 2023 due date. Whether you     will extend your time to file to Nov. 15, 2023).        Taxpayer Information Management Engine 
owe additional tax, are due a refund, or are                                                            (INTIME), at intime.dor.in.gov. 
breaking even, you still need to file for an    Interest is due on all amounts paid after the 
extension.                                      April 18, 2023 due date.                                Claim your payment. Add your extension 
                                                                                                        payment to any estimated tax paid, and 
How to get an extension of time to file. If     Penalty will not be due if you:                         report on line 3 of either the Form IT-40, 
you filed for a federal extension of time to       File by Nov. 15, 2023;                             Schedule 5, or Form IT-40PNR, Schedule F.
file (Form 4868) by April 18, 2023, then you       Paid at least 90% of the tax you 
automatically have an extension with Indiana.        expected to owe by April 18, 2023, and             Military personnel stationed in a 
If not, you may file Form IT-9 to request an       Pay any remaining amount due when                  presidentially declared combat zone 
extension with Indiana.                              you file.                                          should see the Form IT-40 or Form IT-
                                                                                                        40PNR instruction booklet for special 
Filing due date. Both the federal extension     How to file. Complete the worksheet below               filing instructions. You can access these 
(Form 4868) and Indiana extension (Form         to figure how much you will need to pay. If             instructions online at www.in.gov/dor/
IT-9) extend the time to file your Indiana tax  filing a joint return, include your spouse’s            tax-forms/indiana-state-prior-year-tax-
return to Nov. 15, 2023.                        income. If you don’t owe, complete Part 2:              forms/2019-individual-income-tax-forms/.
                                                Nonpayment Information on the front of this 
What if you owe? Filing for an extension        form.
does not also extend the deadline for paying 
any tax due. If you expect to owe when you      How to pay. If paying, make your check 
file your tax return, you should pay at least   or money order payable to the Indiana 
90% of the amount you expect to owe by the      Department of Revenue. Write your Social 
April 18, 2023 original due date. You may       Security number on your check or money 
make a payment with the filing of Form IT-9     order.                                                  
or online. Simply visit DOR’s e-services 

Worksheet to figure your 2022 extension payment – see instructions below
A. Total estimated income for 2022 .................................................................................................................................... A   ______________
B. Total exemption amount (see Line B instructions below) ............................................................................................... B  ______________
C. Amount subject to tax (line A minus line B) .................................................................................................................... C  ______________
D. Amount of state income tax due (line C x .0323) ........................................................................................................... D  ______________
E. Amount of county income tax due (line C x the appropriate county tax rate(s); see Line E instructions below) ............  E  ______________
F. Anticipated state and county tax due for 2022 (add line D and line E) .......................................................................... F  ______________
G. Subtotal: multiply line F by 90% (.90) ............................................................................................................................. G  ______________
H. Total credits (including 2022 state and county income tax withheld, estimated tax payments, etc.).............................. H  ______________
I. Minimum required extension payment: line G minus line H ....... Enter on Part 1: Payment Information, line 4 ........  I    ______________
J.  Enter portion of line I that represents your state tax due ........... Enter on Part 1: Payment Information, line 1 ........  J   ______________
K. Enter portion of line I that represents your (and spouse’s if same county) county tax due. 
   Enter 2-digit county code (from county tax chart)           Enter on Part 1: Payment Information, line 2b ..........  K  ______________
L. Enter portion of line I that represents spouse’s county tax due if for a different county than the one on line K.  
   Enter 2-digit county code (from county tax chart)           Enter on Part 1: Payment Information, line 3b ..........  L   ______________

Line B – Enter the total amount of              www.in.gov/dor/tax-forms/2022-individual-               Line J – Enter the amount from line I that 
exemptions you are eligible to claim on         income-tax-forms/.                                      represents the portion of Indiana state 
Indiana’s Schedule 3, line 7, or Schedule D,                                                            income tax you are paying on Part 1: 
line 9. Limitation. If you are a nonresident    Line H – Enter your anticipated credits,                Payment Information, line 1, on the front of 
alien (not a U.S. citizen and do not meet       including 2022 state and county withholding             this form.
the green card test) you may claim only one     amounts, estimated tax payments, and any 
$1,000 exemption (even if married filing        other credits you may have.                             Lines K and L – If the amount on line I also 
jointly and/or with dependents).                                                                        includes county tax, enter that portion on Part 
                                                Line I – This is your extension payment.                1: Payment Information, line 2b, on the front 
Line E – Multiply the amount on line C by the   Enter this amount on Part 1: Payment                    of this form. Only break out your spouse’s 
appropriate county tax rate(s). Find your       Information, line 4, on the front of this form.         county tax if spouse owes tax to a county 
county tax rate and 2-digit county code                                                                 other than yours. Enter that portion on Part 1: 
number on the chart on page 2 of Schedule                                                               Payment Information, line 3b.
CT-40 or Schedule CT-40PNR, located at 

                                                *24100000000*
                                                               24100000000






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