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04           Form                                Indiana Full-Year Resident 
                                                                                                          Due April 15, 2024 
05      IT-40               2023                 Individual Income Tax Return 
        State Form 154
06      (R22 / 9-23)        If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY): 
07                                                                                                            Place “X” in box
08                                from 99        99       9999     to:      99    99        9999              if amending         X
09
10 Your Social                                                    Spouse’s Social 
11 Security Number    999              99        9999             Security Number       999    99           9999
12
13                    X     Place “X” in box if applying for ITIN                      X    Place “X” in box if applying for ITIN
14 Your first name                               Initial  Last name                                                         Suffix
15
16      XXXXXXXXXXXXXXX                          X          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                      XXXXX
17 If filing a joint return, spouse’s first name Initial  Last name                                                         Suffix
18
19      XXXXXXXXXXXXXXX                          X          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                      XXXXX
20 Present address (number and street or rural route) 
21                                                                                                    Place “X” in box if you are 
22                    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                  married filing separately.  X
23 City                                                                     State              ZIP/Postal code
24
25             XXXXXXXXXXXXXXXXXXXX                                               XX             9999999999
26 Foreign country 2-character code (see instructions) 
27
28 XX
29
30 Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and 
31 worked on Jan. 1, 2023.
32 County where             County where                                  County where         County where 
33 you lived       99       you worked           99                       spouse lived      99 spouse worked    99
34
35                                                                                                          Round all entries
36 1.  Enter your federal adjusted gross income from your federal  
37 income tax return, Form 1040 or Form 1040-SR, line 11 _____________________ Federal AGI                1 99999999999.00
38
39 2.  Enter amount from Schedule 1, line 7, and enclose Schedule 1 ________  Indiana Add-Backs           2 99999999999.00
40
41 3.  Add line 1 and line 2 ____________________________________________________________                 3 99999999999.00
42
43 4.  Enter amount from Schedule 2, line 12, and enclose Schedule 2 _______  Indiana Deductions          4 99999999999.00
44
45 5.  Subtract line 4 from line 3 ________________________________________________________               5 99999999999.00
46
47 6.  Complete Schedule 3. Enter amount from Schedule 3, line 7,  
48 and enclose Schedule 3 _______________________________________ Indiana Exemptions                      6 99999999999.00
49
50 7.  Subtract line 6 from line 5 ____________________________ Indiana Adjusted Gross Income             7 99999999999.00
51 8.  State adjusted gross income tax: multiply line 7 by 3.15% (.0315) 
52 (if answer is less than zero, leave blank) ____________________   8            99999999999  .00
53 9.  County tax. Enter county tax due from Schedule CT-40 
54 (if answer is less than zero, leave blank) ____________________   9            99999999999  .00
55
56 10.  Other taxes. Enter amount from Schedule 4, line 4 (enclose schedule)   10 99999999999  .00
57
58 11.  Add lines 8, 9 and 10. Enter total here and on line 15 on the back  ___________ Indiana Taxes 11    99999999999.00
59
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05 12.  Enter credits from Schedule 5, line 13 (enclose schedule) ___  12    99999999999.00
06
07 13.  Enter offset credits from Schedule 6, line 8 (enclose schedule)  13  99999999999.00
08
                                                                                                                      99999999999
09 14.  Add lines 12 and 13  ______________________________________________ Indiana Credits                        14     .00
10
11 15.  Enter amount from line 11 ___________________________________________                    Indiana Taxes     15 99999999999.00
12
13 16.  If line 14 is equal to or more than line 15, subtract line 15 from line 14 (if smaller, skip to line 23)   16 99999999999.00
14
15 17.  Enter donations from Schedule IN-DONATE (enclose schedule); cannot be greater than line 16                 17 99999999999.00
16
17 18.  Subtract line 17 from line 16 __________________________________________Overpayment                        18 99999999999.00
18
19 19.  Amount from line 18 to be applied to your 2023 estimated tax account (see instructions). 
20
21   Enter your county code      99      county tax to be applied _ $  a     99999999999                 .00 
22
23   Spouse’s county code        99      county tax to be applied _$   b     99999999999                 .00 
24
25   Indiana adjusted gross income tax to be applied _________ $           c 99999999999                 .00
26
27   Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18) _____         19d     99999999999.00
28
29 20.  Penalty for underpayment of estimated tax from Schedule IT-2210 and IT-2210A  ___________   20                99999999999.00
30
31   a. Enter Code A if annualizing. Enter Code F if Farmer or Fisherman __________                    a X
32
33 21.  Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 instructions   __ Your Refund 21 99999999999.00
34
35 22.  Direct Deposit (see instructions)
36
37   a.  Routing Number     9 9 9 9 9 9 9 9 9
38
39   b.  Account Number     9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
40
41   c.  Type: X      Checking   X   Savings    X          Hoosier Works MC
42
43   d.  Place an “X” in the box if refund will go to an account outside the United States X
44
45 23.  If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on 
46    line 20 (see instructions) _______________________________________________________   23                         99999999999.00
47
48 24.  Penalty if filed after due date (see instructions) ______________________________________   24                99999999999.00
49
50 25.  Interest if filed after due date (see instructions) ______________________________________   25               99999999999.00
51
52 26.  Amount Due: Add lines 23, 24 and 25 ______________________________ Amount You Owe                          26 99999999999.00 
53   Do not send cash. Make your check or money order payable to:  
54   Indiana Department of Revenue. See instructions if paying with a credit card.
55
   Sign and date this return after reading the Authorization statement on Schedule 7. Remember to enclose Schedule 7.
56
57 _____________________________________________________                    _________________________________________________
58 Signature                                               Date            Spouse’s Signature                         Date
59 • Mail payments to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224. 
60 • Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.
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