Schedule D                                    Schedule D: Exemptions                                          Enclosure 
   Form IT-40PNR, State Form 54032                                                                      Sequence No. 04
   (R14 / 9-23)                                                                                 2023

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

Complete and enclose Schedule IN-DEP: Dependent Information and Additional Dependent Child Information if you are claiming 
dependents on lines 2 and/or 3 below. Complete and enclose Schedule IN-DEP-A: Adopted Dependent Information if you are 
claiming dependents on line 6 below.
                                                                                                      Round all entries

1. Enter $2000 if you are married filing jointly; otherwise, enter $1000 ________________________   1                  .00

2. Enter the number of dependents listed on Schedule IN-DEP, Box 5           x $1000 _________      2                  .00 
You MUST enclose Schedule IN-DEP.

3. You may claim an additional exemption for each qualifying dependent child:
   • who is a son, stepson, daughter, stepdaughter, foster child and/or child for whom you are a  
     legal guardian;
   • who was under the age of 19 by Dec. 31, 2023; or
   • who is a full-time student who was under the age of 24 by Dec. 31, 2023; and
   • who you are eligible to claim as a dependent on line 2 above.

Enter the number of additional dependents
listed on Schedule IN-DEP, Box 6.                     x $1500 ____________________________          3                  .00

4. Place “X” in box(es) below if, by December 31, 2023

     You were age 65 or older            and/or blind

     Spouse was 65 or older              and/or blind

Total number of boxes with Xs                 x $1000 _____________________________________         4                  .00

5. If age 65 or older, enter amount from Schedule A, line 36A $ 
   • If filing as married filing separately and this amount is less than $20,000, place “X” in  
     the “You were age 65 or older” box below. 
   • For all other filers age 65 or older, if this amount is less than $40,000, place “X” in  
     appropriate box(es) below.

     You were age 65 or older

     Spouse was 65 or older

Total number of boxes with Xs                 x $500 _______________________________________      5                    .00

6. Enter the number of additional adopted child  
exemptions listed on Schedule IN-DEP-A, Box 6         x $3000 ________________________            6                    .00 
You MUST enclose Schedule IN-DEP-A.

7. Add lines 1, 2, 3, 4, 5 and 6  _______________________________________________________           7                  .00

8. Enter the number from Schedule A, Proration Section, line 21D ___________________________        8  .

9. Multiply line 7 by line 8. Enter here and on Form IT-40PNR, line 6 __________Total Exemptions  9                    .00

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