Schedule 5 / Schedule IN-DONATE                 Schedule 5: Credits                                          Enclosure 
    Form IT-40, State Form 53998                                                                          Sequence No. 04
    (R14 / 9-23)                                                                           2023

Name(s) shown on Form IT-40                                                           Your Social Security Number

                                                                                                          Round all entries

1. Indiana state tax withheld: See instructions ___________________________________________            1                   .00

2. Indiana county tax withheld: See instructions  _________________________________________            2                   .00

3. Pass Through Entity Tax Credit  ____________________________________________________                3                   .00

4. Estimated tax paid for 2023: include any extension payment made with Form IT-9  ____________        4                   .00

5. Unified tax credit for the elderly ____________________________________________________             5                   .00

6. Earned income credit: enclose Schedule IN-EIC and enter amount from line A-3  _____________         6                   .00

7. Lake County residential income tax credit ____________________________________________              7                   .00

8. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,  
line 19 (enclose schedule) ________________________________________________________                    8                   .00

9. Economic development for a growing economy retention credit. Enter amount from  
Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________                  9                   .00

10. Headquarters relocation credit (refundable portion - see instructions)  ______________________     10                  .00

11. Adoption Credit  ________________________________________________________________                  11                  .00

12. Reserved for future use __________________________________________________________                 12                  .00

13. Add lines 1 through 12. Enter total here and on Form IT-40, line 12 _____________Total Credits     13                                    .00

                                                    Schedule IN-DONATE
                        Important: The amount on line 2 cannot exceed the amount on Form IT-40, line 16.

1. Donations: List fund name, 3-digit code and amount to be donated (see instructions)

    a.  Enter fund name                                                  code no.                  1a                      .00

    b.  Enter fund name                                                  code no.                  1b                      .00

    c.  Enter fund name                                                  code no.                  1c                      .00 

2. Add lines 1a through 1c. Enter total here and on Form IT-40, line 17  Total Donations           2                       .00

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