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04    Schedule D                                    Schedule D: Exemptions                                          Enclosure 
05    Form IT-40PNR, State Form 54032                                                                    Sequence No. 04
      (R14 / 9-23)                                                                                 2023
06
07 Name(s) shown on Form IT-40PNR                                                        Your Social Security Number
08
09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                               999 99  9999
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   Complete and enclose Schedule IN-DEP: Dependent Information and Additional Dependent Child Information if you are claiming 
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   dependents on lines 2 and/or 3 below. Complete and enclose Schedule IN-DEP-A: Adopted Dependent Information if you are 
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   claiming dependents on line 6 below.
13                                                                                                       Round all entries
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15 1. Enter $2000 if you are married filing jointly; otherwise, enter $1000 ________________________   1 99999999999.00
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17 2. Enter the number of dependents listed on Schedule IN-DEP, Box 5       99  x $1000 _________      2 99999999999.00 
18 You MUST enclose Schedule IN-DEP.
19
20 3. You may claim an additional exemption for each qualifying dependent child:
21    • who is a son, stepson, daughter, stepdaughter, foster child and/or child for whom you are a  
22      legal guardian;
23    • who was under the age of 19 by Dec. 31, 2023; or
24    • who is a full-time student who was under the age of 24 by Dec. 31, 2023; and
25    • who you are eligible to claim as a dependent on line 2 above.
26
27 Enter the number of additional dependents
28 listed on Schedule IN-DEP, Box 6.                99    x $1500 ____________________________         3 99999999999.00
29
30 4. Place “X” in box(es) below if, by December 31, 2023
31
32         You were age 65 or older    X    and/or blind X
33
34         Spouse was 65 or older      X    and/or blind X
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36 Total number of boxes with Xs        99       x $1000 _____________________________________         4  99999999999     .00
37
38 5. If age 65 or older, enter amount from Schedule A, line 36A $ 99999999999999999999
39    • If filing as married filing separately and this amount is less than $20,000, place “X” in  
40      the “You were age 65 or older” box below. 
41    • For all other filers age 65 or older, if this amount is less than $40,000, place “X” in  
42      appropriate box(es) below.
43
44         You were age 65 or older    X
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46         Spouse was 65 or older      X
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48 Total number of boxes with Xs       99        x $500 _______________________________________      5   99999999999      .00
49
50 6. Enter the number of additional adopted child  
51 exemptions listed on Schedule IN-DEP-A, Box 6         99 x $3000 ________________________         6   99999999999.00 
52 You MUST enclose Schedule IN-DEP-A.
53
54 7. Add lines 1, 2, 3, 4, 5 and 6  _______________________________________________________           7 99999999999      .00
55
56 8.Enter the number from Schedule A, Proration Section, line 21D ___________________________         8  .9999
57
58 9. Multiply line 7 by line 8. Enter here and on Form IT-40PNR, line 6 __________Total Exemptions  9   99999999999      .00
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62                                          *23723111694*
63                                                          23723111694
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