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04     Form                                       INDIANA DEPARTMENT OF REVENUE
05      IT-41                              FIDUCIARY INCOME TAX RETURN
   State Form 11458                                                                                                2023
06 (R19 / 8-23)
07 Check box 
08 if amended     X           For the calendar year 2023 or fiscal year beginning    99  99 2023          and ending     99  99 9999
09                                                                                  MM D D                                 MM D D  Y Y Y Y
10 Name of Estate or Trust                                                      Address
11
12     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                      XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13 Name and Title of Fiduciary                                                  City                               State ZIP Code
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15     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                      XXXXXXXXXXXXXXX                    XX    999999999
16 2-Digit County Code        Federal Employer Identification Number            Foreign Country 2-Character Code
17
18      XX                                 999999999                              XX                                     Please round entries 
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20 1.  Taxable income of fiduciary from federal Form 1041  _____________________________________________           1     99999999999.00
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22 2.  Indiana additions or add-backs, see line 2 instructions  ___________________________________________        2     99999999999.00
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24 3.  IRC Section 965 Income  __________________________________________________________________                  3     99999999999.00
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26 4.  Net operating loss deduction from federal return  ________________________________________________          4     99999999999.00
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28 5.  Add lines 1 through 4 __________________________________________________________ Total Income                 5   99999999999.00
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30 6.  Interest on U.S. Government Obligations reported on federal return   ________________________________       6     99999999999.00
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32 7.  Non-Indiana fiduciary income _______________________________________________________________                7     99999999999.00
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34 8.  Indiana portion of net operating loss deduction (enclose Schedule IT-40NOL, see instructions) ____________  8     99999999999.00
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36 9.  Line 5 minus lines 6 through 8 ____________________________________________ State Taxable Income            9     99999999999.00
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38 10.  State Adjusted Gross Income Tax: multiply line 9 by .0315 ________________________________________         10    99999999999.00
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40 11. Other Taxes from Form IT-41, Schedule 1, line 6  _______________________________________________            11    99999999999.00
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42 12. Add lines 10 and 11  _______________________________________________________________Total Tax               12    99999999999.00
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44 13.  Fiduciary estimated tax paid  _______________________________________________________________              13    99999999999.00
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46 14.  Other Credits (You MUST enclose verification), see line 14 instructions ______________________________     14    99999999999.00
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48 15. Add lines 13 and 14  ___________________________________________________________ Total Credits              15    99999999999.00
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50 16. If line 12 is greater than line 15, enter the difference  __________________________________ Balance Due    16    99999999999.00
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52 17.  Penalty, see line 17 instructions _____________________________________________________________            17    99999999999.00
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54 18.  Interest ,see line 18 instructions _____________________________________________________________           18    99999999999.00
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56 19. Total Amount Due (Add lines 16 through 18)  _______________________________________ Payment Due             19    99999999999.00
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58 20. Refund Due (If line 15 is greater than line 12, enter the difference)  __________________________  Refund   20    99999999999.00
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05 Name of Estate or Trust                                                                                Federal Employer Identification Number
06
07           XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                          999999999
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09 Check Applicable Boxes                                                                                   Federal                              State
10 First Return               Final Return       Fiduciary Name Change                     Address Change Extension                           Extension
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12 X                                 X                                   X                           X      X                                    X
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14 Retirement Plan     Estate Simple Trust    Complex Trust              Bankruptcy Estate           ESBT Grantor Trust  Other (Please Specify)     
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16 X                     X           X           X                                  X               X     X        XXXXXXXXXX
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18 Additional Information - Please answer the following questions or provide the requested information.
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20 1. Is there a nonresident beneficiary? Yes X  No X
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22 2. How many Schedule IN K-1s are included with this return?             999
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24 3. If this is an estate return, enter the date of the decedent’s death and Social Security number
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26 Decedent’s date of death          99999999                      Decedent’s Social Security Number      999999999
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28 4. If this is a trust return, enter date the entity was created 99999999             5. Was a final individual return filed for decedent? Yes X No X
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30 6. If this is a grantor trust return, enter the grantor’s Social Security number     999999999
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32 I authorize the department to discuss my return with my personal                 Address
33 representative.
34                                                                                  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
35       Yes X  No X       If yes, complete the information below. 
                                                                                    City
36
37 Personal Representative’s Name (please print)                                          XXXXXXXXXXXXXXXXXXXXXX
38                                                                                  State                 ZIP Code 
39 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
40 Email                                                                                   XX               999999999
41 Address      999999999999999999999999999999
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   Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge 
44 and belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is based upon all information of which the 
45 preparer has any knowledge.
46
47 Signature of Fiduciary or Officer             Telephone Number                          Date
                                                                                                          Mail completed return with 
48                                                                 9999999999              99999999                payment to:
49                                                                                                                  Indiana  
50 Signature of Preparer                         Telephone Number                          Date             Department of Revenue
51                                                                                                          Fiduciary Section
52                                                                 9999999999              99999999                P.O. Box 6192
53 Preparer's Address                            Preparer's Identification Number                         Indianapolis, IN 46206-6192

54                                                                                                        Mail all other returns to:
55 XXXXXXXXXXXXXXXXXXXXXXXXX                                               999999999                                Indiana
56 City                                                            State                ZIP Code            Department of Revenue
57                                                                                                          Fiduciary Section
   XXXXXXXXXXXXXXXXXXXXXX                                          XX                     999999999                P.O. Box 6079
58                                                                                                        Indianapolis, IN 46206-6079
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