01
0000000000111111111122222222223333333333444444444455555555556666666666777777777788888
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04   Schedule IN-W                               Schedule IN-W:                                                     Enclosure 
     Form IT-40, IT-40PNR, IT-40RNR                                                             Sequence No. 26
05   State Form 53056 (R / 9-23)             Indiana Withholding Statements
                                                                                            2023
06
07 Name(s) shown on Form IT-40/IT-40PNR/IT-40RNR                                     Your Social Security Number
08
09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                   99999999999999999999999
10
11   A         B                 C               D                         E         F          G                   H
12   Social Security  Form       Employer or     State          State Tax            Local      Local Tax           Locality 
     Number    Code Payer ID Number          Income             Withheld             Income     Withheld            Code
13
14 1
     9999999999999999999999999999999999999999999999999999999999999999999999999
15 2
16   9999999999999999999999999999999999999999999999999999999999999999999999999
17 3
     9999999999999999999999999999999999999999999999999999999999999999999999999
18 4
19   9999999999999999999999999999999999999999999999999999999999999999999999999
20 5
     9999999999999999999999999999999999999999999999999999999999999999999999999
21 6
22   9999999999999999999999999999999999999999999999999999999999999999999999999
23 7
     9999999999999999999999999999999999999999999999999999999999999999999999999
24 8
25   9999999999999999999999999999999999999999999999999999999999999999999999999
26 9
     9999999999999999999999999999999999999999999999999999999999999999999999999
27 10
28   9999999999999999999999999999999999999999999999999999999999999999999999999
29 11
     9999999999999999999999999999999999999999999999999999999999999999999999999
30 12
31   9999999999999999999999999999999999999999999999999999999999999999999999999
32 13
     9999999999999999999999999999999999999999999999999999999999999999999999999
33 14
34   9999999999999999999999999999999999999999999999999999999999999999999999999
35 15
     9999999999999999999999999999999999999999999999999999999999999999999999999
36 16
37   9999999999999999999999999999999999999999999999999999999999999999999999999
38 17
     9999999999999999999999999999999999999999999999999999999999999999999999999
39 18
40   9999999999999999999999999999999999999999999999999999999999999999999999999
41 19
     9999999999999999999999999999999999999999999999999999999999999999999999999
42 20
43   9999999999999999999999999999999999999999999999999999999999999999999999999
44 21
     9999999999999999999999999999999999999999999999999999999999999999999999999
45 22
46   9999999999999999999999999999999999999999999999999999999999999999999999999
47 23
     9999999999999999999999999999999999999999999999999999999999999999999999999
48 24
49   9999999999999999999999999999999999999999999999999999999999999999999999999
50 25
     9999999999999999999999999999999999999999999999999999999999999999999999999
51   Add lines 1 through 25 column E. Enter total on line 1 of  
52 26 IT-40 Schedule 5, or line 1 of IT-40PNR Schedule F, or  
     line 7 of IT-40RNR.                                        999999999999
53
     Add lines 1 through 25 column G. Enter total on line 2 of IT-40 Schedule 5, or  
54 27
     line 2 of IT-40PNR Schedule F, or line 8 of IT-40RNR.
55                                                                                           999999999999
56
57                                           Schedule IN-W Reference Chart
58   Form Type                   Form Code   Form Type                     Form Code Form Type  Form Code
59   W2/W2C                      W               1099R                     R         1099G                      U   
60   W2G                         G               1099M                     M         1099NEC                    N
61
62                                           *26123111694*
63                                                              26123111694
64
65
66