01 0000000000111111111122222222223333333333444444444455555555556666666666777777777788888 1234567890123456789012345678901234567890123456789012345678901234567890123456789012345 04 Form Indiana Part-Year or Full-Year Nonresident IT-40PNR 05 State Form 472 Individual Income Tax Return 2023 06 (R22 / 9-23) If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY): Due April 15, 2024 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-40PNR) 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. Complete Schedule A first. Enter here the amount from Section 3, line 36B, and enclose 37 Schedule A ______________________________________________________ Indiana Income 1 99999999999.00 38 39 2. Enter amount from Schedule B, line 6, and enclose Schedule B __________ 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 C, line 12, and enclose Schedule C ________ Indiana Deductions 4 99999999999.00 44 45 5. Subtract line 4 from line 3 _________________________________________________________ 5 99999999999.00 46 47 6. You must complete Schedule D. Enter amount from Schedule D, line 9, 48 and enclose Schedule D ________________________________________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-40PNR 54 (if answer is less than zero, leave blank) _____________________ 9 99999999999 .00 55 56 10. Other taxes. Enter amount from Schedule E, line 5 (enclose sch.) 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 60 61 62 *15723111694* 63 15723111694 64 65 66 |
01 0000000000111111111122222222223333333333444444444455555555556666666666777777777788888 1234567890123456789012345678901234567890123456789012345678901234567890123456789012345 04 05 12. Enter credits from Schedule F, line 13 (enclose schedule) ___ 12 99999999999.00 06 07 13. Enter offset credits from Schedule G, line 8 (enclose schedule) 13 99999999999 .00 08 09 14. Add lines 12 and 13 _______________________________________________ Indiana Credits 14 99999999999.00 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 2024 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 line 20 46 (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. Please make your check or money order payable to: 54 Indiana Department of Revenue. See instructions if paying by credit card. 55 Sign and date this return after reading the Authorization statement on Schedule H. You must enclose Schedule H (both pages). 56 57 _____________________________________________________ _________________________________________________ 58 Your Signature Date Spouse’s Signature Date 59 • If enclosing payment mail 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. 61 62 *15723121694* 63 15723121694 64 65 66 |