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04 Form IT-41                                           Indiana Department of Revenue
   State Form 11458 
05 (R20 / 8-24)                                         Fiduciary Income Tax Return                                  2024
06
07 Check box  
08 if amended        X       For the calendar year 2024 or fiscal year beginning    99  99 2024            and ending    99  99 9999
09                                                                                  MM D D                               MM D D  Y Y Y Y
10 Name of Estate or Trust                                                     Address
11
12     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13 Name and Title of Fiduciary                                                 City                                State ZIP Code
14
15     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                     XXXXXXXXXXXXXXX                       XX  999999999
16 2-Digit County Code       Federal Employer Identification Number            Foreign Country 2-Character Code
17
18     XX                                 999999999                              XX                                      Please round entries 
19
20 1.  Taxable income of fiduciary from federal Form 1041  ______________________________________________          1  99999999999.00
21
22 2.  Indiana additions or add-backs, see line 2 instructions  ____________________________________________    2     99999999999.00
23
24 3.  IRC Section 965 Income  ___________________________________________________________________                 3  99999999999.00
25
26 4.  Net operating loss deduction from federal return  _________________________________________________         4  99999999999.00
27
28 5.  Add lines 1 through 4 ___________________________________________________________ Total Income    5            99999999999.00
29
30 6.  Interest on U.S. Government Obligations reported on federal return   _________________________________      6  99999999999.00
31
32 7.  Non-Indiana fiduciary income ________________________________________________________________               7  99999999999.00
33
34 8.  Indiana portion of net operating loss deduction (enclose Schedule IT-40NOL, see instructions) _____________ 8  99999999999.00
35
36 9.  Line 5 minus lines 6 through 8 _____________________________________________   State Taxable Income         9  99999999999.00
37
38 10.  State Adjusted Gross Income Tax: multiply line 9 by .0305 _________________________________________   10      99999999999.00
39
40 11. Other Taxes from Form IT-41, Schedule 1, line 6  ________________________________________________   11         99999999999.00
41
42 12. Add lines 10 and 11  _______________________________________________________________ Total Tax  12             99999999999.00
43
44 13. Fiduciary estimated tax paid  ________________________________________________________________   13            99999999999.00
45
46 14.  Other Credits (You MUST enclose verification), see line 14 instructions _______________________________   14  99999999999.00
47
48 15.  Add lines 13 and 14  ____________________________________________________________ Total Credits  15           99999999999.00
49
50 16.  If line 12 is greater than line 15, enter the difference  ___________________________________ Balance Due  16 99999999999.00
51
52 17. Penalty, see line 17 instructions ______________________________________________________________   17          99999999999.00
53
54 18. Interest ,see line 18 instructions ______________________________________________________________   18         99999999999.00
55
56 19. Total Amount Due (Add lines 16 through 18)  ________________________________________         Payment Due  19   99999999999.00
57
58 20. Refund Due (If line 15 is greater than line 12, enter the difference)  ___________________________  Refund  20 99999999999.00
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04
05 Name of Estate or Trust                                                                                  Federal Employer Identification Number
06
07          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                             999999999
08
   Check Applicable Boxes
09                                                                                                            Federal         State 
   First Return                Final Return              Fiduciary Name Change             Address Change   Extension Extension
10
11
12    X                              X                               X                                X       X                X
13 Retirement Plan    Estate   Simple Trust        Complex Trust         Bankruptcy Estate             ESBT Grantor Trust  Other (Please Specify)
14
15    X               X              X                   X                         X                  X     X        XXXXXXXXXX
16
   Additional Information – Please answer the following questions or provide the requested information.
17
18
   1. Enter the total number of beneficiaries
19                                           999999
20
   2. Enter the number of nonresident beneficiaries
21                                                       999999
22
   3. How many Schedule IN K-1s are included with this return?
23                                                                       999
24
   4.  If this is an estate return, enter the date of the decedent’s death and Social Security number 
25
       
26
      Decedent’s date of death                                     Decedent’s Social Security Number
27                             99999999                                                                     999999999
28
   5.  If this is a trust return, enter date the entity was created
29                                                                 99999999
30
   6.  Was a final individual return filed for decedent? Yes         No
31                                                                 X     X
32
   7. If this is a grantor trust return, enter the grantor’s Social Security number
33                                                                                     999999999
34    I authorize the department to discuss my return with my personal             Email 
35    representative.                                                              Address 999999999999999999999999999999
36                                                                                 Address
37      Yes X   No    X     If yes, complete the information below.
38                                                                                 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
39    Personal Representative’s Name (please print)                                City
40
41    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                          XXXXXXXXXXXXXXXXXXXXXX
42    Telephone                                                                    State                    ZIP Code
43    Number    999999999999
44                                                                                         XX                 999999999
45
46 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the 
47 best of my knowledge and belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is 
48 based upon all information of which the preparer has any knowledge.
49 Signature of Fiduciary or Officer                     Telephone Number                  Date             Mail completed return with 
50                                                                                                                   payment to: 
51                                                                 9999999999              99999999                   Indiana  
                                                                                                              Department of Revenue 
52 Signature of Preparer                                 Telephone Number                  Date               Fiduciary Section 
53                                                                                                                   P.O. Box 6192 
54                                                                 9999999999              99999999         Indianapolis, IN 46206-6192
55 Preparer's Address                                    Preparer's Identification Number
56                                                                                                          Mail all other returns to: 
                                                                                                                      Indiana 
57 XXXXXXXXXXXXXXXXXXXXXXXXX                                              999999999                           Department of Revenue 
58 City                                                            State               ZIP Code               Fiduciary Section 
59                                                                                                                   P.O. Box 6079 
60 XXXXXXXXXXXXXXXXXXXXXX                                            XX                  999999999          Indianapolis, IN 46206-6079
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62                                           *24224121694*
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