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

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12.  Enter credits from Schedule F, line 13 (enclose schedule)  ___     12                           .00

13.  Enter offset credits from Schedule G, line 8 (enclose schedule)    13                           .00

14.  Add lines 12 and 13  _______________________________________________                     Indiana Credits   14       .00

15.  Enter amount from line 11  __________________________________________                    Indiana Taxes     15       .00

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       .00

17.  Enter donations from Schedule IN-DONATE (enclose schedule); cannot be greater than line 16                 17       .00

18.  Subtract line 17 from line 16 _________________________________________                  Overpayment       18       .00

19.  Amount from line 18 to be applied to your 2024 estimated tax account (see instructions). 

     Enter your county code              county tax to be applied __ $  a                            .00 

     Spouse’s county code                county tax to be applied __ $  b                            .00 

     Indiana adjusted gross income tax to be applied __________ $       c                            .00

     Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18)  _____           19d     .00

20.  Penalty for underpayment of estimated tax from Schedule IT-2210 and IT-2210A  ____________                 20       .00

     a. Enter code A if annualizing. Enter Code F if Farmer or Fisherman  ___________         a

21.  Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 instructions ____ Your Refund 21       .00

22.  Direct Deposit (see instructions) 

     a. Routing Number

     b. Account Number

     c. Type:      Checking              Savings          Hoosier Works MC

     d. Place an “X” in the box if refund will go to an account outside the United States

23.  If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on line 20 
     and line 21(see instructions)  _____________________________________________________                       23       .00

24.  Penalty if filed after due date (see instructions) _______________________________________                 24       .00

25.  Interest if filed after due date (see instructions) _______________________________________                25       .00

26.  Amount Due: Add lines 23, 24 and 25  ______________________________                      Amount You Owe    26       .00
     Do not send cash. Please make your check or money order payable to:  
     Indiana Department of Revenue. See instructions if paying by credit card.
Sign and date this return after reading the Authorization statement on Schedule H. You must enclose Schedule H (both pages).
_____________________________________________________                         _________________________________________________
Your Signature                                          Date                 Spouse’s Signature                      Date
• If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224. 
• Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

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