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04    Schedule 4                     Schedule 4: Other Taxes                                                 Enclosure 
      Form IT-40, State Form 56540                                                                     Sequence No. 03B
05    (R5 / 9-23)                                                                 2023
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07 Name(s) shown on Form IT-40                                                    Your Social Security Number
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09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                999               99 9999
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13 1. Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet __________________   1 99999999999.00
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15 2. Household employment taxes. Enclose Schedule IN-H __________________________________          2 99999999999.00
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17 3. Recapture of certain Indiana offset credits. Enclose Schedule IN-CR _______________________   3 99999999999.00
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19 4. Add lines 1 through 3. Enter here and on Form IT-40, line 10 ______________ Total Other Taxes 4 99999999999.00
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62                                  *25923111694*
63                                    25923111694
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