Schedule PTET                                   Indiana Department of Revenue
State Form 57284 
(R / 8-24)                Pass Through Entity Tax Return

Check box if no Schedule Composite tax is due (see instructions)                Computation Code

Check box if no Schedule Composite-COR tax is due (see instructions)

Entity’s Tax Year 2024 or Other Year Beginning                   2024 and Ending

  Name of Entity                                                                                Federal Employer Identification Number

See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
Individual’s Social Security Number or Corporate State of        Entity         Adjusted                                                                       Pass Through 
Entity’s Federal Employer Identification Number  Residency          Type        Gross Income                                                                   Entity Tax
                       1                         A                     B                        C                                                              D
                                                 Enter the       Enter the   Adjusted gross income attributed  Multiply C by the 
                                                 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 
                                                 residency                   IN K-1,Part 4, line 9                                                             ending in 2025)
Enter the SSN or FEIN
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
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21.
22. Subtotal Column D .........................................................................................................................................
23. Carryover totals from Column D from additional sheets .................................................................................

24. Total tax (22D + 23D). Enter this amount on line 16 of Form IT-20S;
   line 6c of Form IT-65; or, on Form IT-41, Schedule 1, line 3.. .........................................................Total Tax

                          *24100000000*
                                                           24100000000