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04    Schedule F/ Schedule IN-DONATE          Schedule F: Credits                                                   Enclosure 
05    Form IT-40PNR, State Form 54033                                                                         Sequence No. 05
      (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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11                                                                                                            Round all entries
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13 1. Indiana state tax withheld: See instructions ___________________________________________             1  99999999999.00
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15 2. Indiana county tax withheld: See instructions  _________________________________________             2  99999999999.00
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17 3. Pass Through Entity Tax Credit  ____________________________________________________                  3 99999999999.00
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19 4. Estimated tax paid for 2023: include any extension payment made with Form IT-9  ____________         4  99999999999.00
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21 5. Unified tax credit for the elderly ____________________________________________________              5  99999999999.00
22 6. Earned income credit: see instructions
23    Enter earned income credit from 
24    Schedule IN-EIC, line A-3 _____________________________ Box A           99999999999     .00
25
26    Enter number from Schedule A, Proration Section, line 21D ___ Box B     9.99
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28    Multiply Box A by Box B, enter total here ___________________________________________                6  99999999999.00
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30 7. Lake County residential income tax credit ____________________________________________               7  99999999999.00
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32 8. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,  
33 line 19 (enclose schedule) ________________________________________________________                     8  99999999999.00
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35 9. Economic development for a growing economy retention credit. Enter amount from  
36 Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________                   9  99999999999.00
37
38 10. Headquarters relocation credit (refundable portion - see instructions)  ______________________ 10      99999999999.00
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40 11. Adoption Credit  ________________________________________________________________                   11 99999999999.00
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42 12. Reserved for future use __________________________________________________________             12                       .00
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44 13. Add lines 1 through 12. Enter total here and on Form IT-40PNR, line 12 _________ Total Credits      13 99999999999 .00
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49                                            Schedule IN-DONATE
50                   Important: The amount on line 2 cannot exceed the amount on Form IT-40PNR, line 16.
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52 1. Donations: List fund name, 3-digit code and amount to be donated (see instructions)
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54    a.  Enter fund name   XXXXXXXXXXXXXXXXXXXXXXXXXX code no.                          999          1a      99999999999.00
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56    b.  Enter fund name   XXXXXXXXXXXXXXXXXXXXXXXXXX code no.                          999          1b      99999999999.00
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58    c.  Enter fund name   XXXXXXXXXXXXXXXXXXXXXXXXXX code no.                          999          1c      99999999999.00
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60 2. Add lines 1a through 1c. Enter total here and on Form IT-40PNR, line 17 Total Donations          2      99999999999.00
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62                                          *23823111694*
63                                                     23823111694
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