Schedule IN-W                               Schedule IN-W:                                                     Enclosure 
  Form IT-40, IT-40PNR, IT-40RNR                                                             Sequence No. 26
  State Form 53056 (R / 9-23)             Indiana Withholding Statements
                                                                                         2023

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

  A         B                 C               D                         E         F          G                   H
  Social Security  Form       Employer or     State          State Tax            Local      Local Tax           Locality 
  Number    Code Payer ID Number          Income             Withheld             Income     Withheld            Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
  Add lines 1 through 25 column E. Enter total on line 1 of  
26 IT-40 Schedule 5, or line 1 of IT-40PNR Schedule F, or  
  line 7 of IT-40RNR.
  Add lines 1 through 25 column G. Enter total on line 2 of IT-40 Schedule 5, or  
27
  line 2 of IT-40PNR Schedule F, or line 8 of IT-40RNR.

                                          Schedule IN-W Reference Chart
  Form Type                   Form Code   Form Type                     Form Code Form Type  Form Code
  W2/W2C                      W               1099R                     R         1099G                      U   
  W2G                         G               1099M                     M         1099NEC                    N

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