- 1 -
|
Form Indiana Part-Year or Full-Year Nonresident
IT-40PNR
State Form 472 Individual Income Tax Return 2023
(R22 / 9-23) If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY): Due April 15, 2024
Place “X” in box
from to: if amending
Your Social Spouse’s Social
Security Number Security Number
Place “X” in box if applying for ITIN Place “X” in box if applying for ITIN
Your first name Initial Last name Suffix
If filing a joint return, spouse’s first name Initial Last name Suffix
Present address (number and street or rural route)
Place “X” in box if you are
married filing separately.
City State ZIP/Postal code
Foreign country 2-character code (see instructions)
Enter below the 2-digit county code numbers (found on the back of Schedule CT-40PNR) for the county where you lived and
worked on Jan. 1, 2023.
County where County where County where County where
you lived you worked spouse lived spouse worked
Round all entries
1. Complete Schedule A first. Enter here the amount from Section 3, line 36B, and enclose
Schedule A ______________________________________________________ Indiana Income 1 .00
2. Enter amount from Schedule B, line 6, and enclose Schedule B __________ Indiana Add-Backs 2 .00
3. Add line 1 and line 2 _____________________________________________________________ 3 .00
4. Enter amount from Schedule C, line 12, and enclose Schedule C ________ Indiana Deductions 4 .00
5. Subtract line 4 from line 3 _________________________________________________________ 5 .00
6. You must complete Schedule D. Enter amount from Schedule D, line 9,
and enclose Schedule D ________________________________________Indiana Exemptions 6 .00
7. Subtract line 6 from line 5 ______________________________ Indiana Adjusted Gross Income 7 .00
8. State adjusted gross income tax: multiply line 7 by 3.15% (.0315)
(if answer is less than zero, leave blank) _____________________ 8 .00
9. County tax. Enter county tax due from Schedule CT-40PNR
(if answer is less than zero, leave blank) _____________________ 9 .00
10. Other taxes. Enter amount from Schedule E, line 5 (enclose sch.) 10 .00
11. Add lines 8, 9 and 10. Enter total here and on line 15 on the back _____________ Indiana Taxes 11 .00
*15723111694*
15723111694
|