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04 Schedule PTET                                   Indiana Department of Revenue
   State Form 57284 
05 (R / 8-24)                Pass Through Entity Tax Return
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07 Check box if no Schedule Composite tax is due (see instructions)                Computation Code
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09 Check box if no Schedule Composite-COR tax is due (see instructions)
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11 Entity’s Tax Year 2024 or Other Year Beginning                   2024 and Ending
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13   Name of Entity                                                                                Federal Employer Identification Number
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16 See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
17 Individual’s Social Security Number or Corporate State of        Entity         Adjusted                                                                       Pass Through 
18 Entity’s Federal Employer Identification Number  Residency          Type        Gross Income                                                                   Entity Tax
19                        1                         A                      B                       C                                                              D
20                                                  Enter the       Enter the   Adjusted gross income attributed  Multiply C by the 
21                                                  2-character     entity type to Indiana from IT-20S/IT-65                                                      individual tax rate 
                                                    state of                    IN K-1, Part 4, Line 9, or IT-41                                                  (.0305; .03 for years 
22                                                  residency                   IN K-1,Part 4, line 9                                                             ending in 2025)
23 Enter the SSN or FEIN
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56 22. Subtotal Column D .........................................................................................................................................
57 23. Carryover totals from Column D from additional sheets .................................................................................
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59 24. Total tax (22D + 23D). Enter this amount on line 16 of Form IT-20S; 
60    line 6c of Form IT-65; or, on Form IT-41, Schedule 1, line 3.. .........................................................Total Tax
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62                           *24100000000*
63                                                            24100000000
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