Enlarge image
01
0000000000111111111122222222223333333333444444444455555555556666666666777777777788888
1234567890123456789012345678901234567890123456789012345678901234567890123456789012345
04 Form Reciprocal Nonresident Indiana
05 IT-40RNR Individual Income Tax Return Place "X" in box
State Form 44406
06 (R22 / 9-23) Due April 15, 2024 2023 if amending
07 Your Social Spouse’s Social Check the box if you are
08 Security Number Security Number married filing separately.
09
Your first name Initial Last name Suffix
10
11
If filing a joint return, spouse’s first name Initial Last name Suffix
12
13
Present address (number and street or rural route) Foreign country
14 2-character code
15
City State ZIP/Postal code
16 If any individual listed above died during
2023, enter date of death below (MMDD).
17
18 Enter the 2-digit code numbers (see instructions) for the county and/or state where you lived Taxpayer's
and worked on Jan. 1, 2023. date of death 2023
19
Yourself Spouse
20 Spouse’s
State where County where State where County where
21 you lived you worked you lived you worked date of death 2023
22
23 Your State of Residence: Check the appropriate box to indicate your state of residence for 2023.
24
25 Kentucky Michigan Ohio Pennsylvania Wisconsin Important: You must file
Form IT-40PNR if you have
26
Note: You must file Form IT-40PNR, Part-Year Resident or Nonresident Indiana Individual Income Tax Indiana riverboat winnings.
27 Return, if you were a resident of a state other than those listed; had Indiana income other than wages,
28 salaries, tips or commissions; or were a part-year resident of Indiana during 2023.
29
30
31
32 Read Instructions First Yours (A) Spouse's (B)
33 1. Enter gross income from your Indiana employment .................. 1A 00 1B 00
34 2. Allowable deductions: attach federal Schedule 1 ........................ 2A 00 2B 00
35 3. Indiana adjusted gross income: line 1 minus line 2 ..................... 3A 00 3B 00
36
37 4. County tax rate from chart (see instructions) .............................. 4A . 4B .
38 5. County tax due: multiply line 3 x line 4 ....................................... 5A 00 5B 00
39 6. Total county tax due: add lines 5A and 5B ......................................................................... Total Tax 6 00
40
41 7. Indiana state tax withheld: See Instructions ...................................................................................... 7 00
42 8. Indiana county tax withheld: See Instructions .................................................................................... 8 00
43 9. Add lines 7 and 8 ......................................................................................................... Total Credits 9 00
44
45 10. Overpayment: if line 9 is more than line 6, subtract line 6 from line 9 and enter amount to be
46 refunded to you ............................................................................................................ Your Refund 10 00
47 11. a. Routing Number c. Type: Checking Savings
48 Direct
49 b. Account Number Deposit
(see instructions)
50 d. Place an “X” in the box if refund will go to an account outside the United States
51 12. Subtract line 9 from line 6 if line 6 is greater than line 9..................................................................... 12 00
52
53 13. Penalty if filed after the due date (see instructions) ........................................................................... 13 00
54 14. Interest if filed after the due date (see instructions) ........................................................................... 14 00
55 15. Total amount you owe: add lines 12, 13 and 14 ................................................... Amount You Owe 15 00
56
57 Do not send cash. Please make your check or money order payable to:
58 Indiana Department of Revenue. See instructions if paying by credit card or electronic check.
59
60
61
62 *16023111694*
63 16023111694
64
65
66
