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04 IT-41                                                                                                             Indiana Department of Revenue
05 2024 Schedule IN K-1                                                                    Beneficiary’s Share of Indiana Adjusted Gross Income, 
   State Form 55891 
06 (R11 / 8-24)                                                                                      Deductions, Modifications, and Credits
07
08                                                                                         Tax Year Beginning 99     99      9999       and Ending      99  99      9999
09
10 Name of Trust or Estate                                                                                                                                  Federal Employer Identification Number
11
12 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                              9999999999
13
14 Amended IN K-1                                                              X           Final IN K-1       X             Nonresident Beneficiary X
15
16 Part 1 – Identification and Distribution Information
17 Provide a copy of this Schedule IN K-1 reflecting the beneficiary’s share of income, deductions, and credits to each beneficiary.  
18 Enclose a copy of each Schedule IN K-1 with the Form IT-41 return when filing. 
19
20 1.                                                                   Beneficiary’s Name
21
22 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
23 2.                                                                   Beneficiary’s FEIN or Social Security Number         3. Beneficiary’s Address
24
25                                                                         9999999999                                        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
26 4.                                                                   Beneficiary’s City                                   5. Beneficiary’s State     6. Beneficiary’s ZIP Code
27
28                                                                          XXXXXXXXXXXXXXXXXXXX                                        XX                  999999999
29 7.                                                                   Beneficiary’s Federal Pro Rata Percentage            8. Indiana County of Principal Employment 2-digit code
30
31                                                                      999.99 %                                             XX
32 9.                                                                   Payer’s Name                                                                    10. Payer’s FEIN
33
34 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                         99999999999
35
36 11.  Pass Through Entity Tax_________________________________________________________                                                                            11  99999999999.00
37
38 12.  IN State Tax Withheld ___________________________________________________________                                                                           12  99999999999.00
39
40 13.  IN County Tax Withheld  _________________________________________________________                                                                           13  99999999999.00
41
42
43 Part 2 – Pro Rata Share of Indiana Pass-through Tax Credits from Trust or Estate
44
45                                                                             Column A                       Column B       Column C                   Column D 
46                                                                          IT-41 Federal ID Number           Certification  Certification/Project/PIN  Tax Credit      Column E 
47                                                                          if Credit is from IN K-1          Year           Number                         Code        Amount Claimed
48
49                                                                      1.  9999999999                        9999           9999999999999999              9999         99999999999.  00
50
51                                                                      2.  9999999999                        9999           9999999999999999              9999         99999999999.  00
52
53                                                                      3.  9999999999                        9999           9999999999999999              9999         99999999999.  00
54
55 Trusts and Estates with more than 9 IN K-1s must file electronically 4.  9999999999                        9999           9999999999999999              9999         99999999999.  00
56
57                                                                      5.  9999999999                        9999           9999999999999999              9999         99999999999.  00
58
59
60
61
62                                                                                                            *24100000000*
63                                                                                                                           24100000000
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04
05
06
07 Part 3 – Distributive Share Amount (use the Indiana apportioned figures for the beneficiary)
08
09 1.  Interest income ________________________________________________________________                 1  99999999999.00
10
11 2.  Ordinary dividends _____________________________________________________________                 2  99999999999.00
12
13 3.  Net short-term capital gains   _____________________________________________________             3  99999999999.00
14
15 4.  Net long-term capital gains _______________________________________________________              4  99999999999.00
16
17 5.  Other portfolio and nonbusiness income ____________________________________________              5  99999999999.00
18
19 6.  Ordinary business income _______________________________________________________                 6  99999999999.00
20
21 7.  Net rental real estate income _____________________________________________________              7  99999999999.00
22
23 8.  Other rental income ____________________________________________________________                 8  99999999999.00
24
25 9.  Directly apportioned deductions ___________________________________________________              9  99999999999.00
26
27 10. Final year deductions ___________________________________________________________                10 99999999999.00
28
29 11. Total pro rata distributions (If lines 1-8 are positive, add them. If lines 1-8 are 
30     negative, see instructions. Also see instructions for reporting lines 9 and 10.) _______________ 11 99999999999.00
31
32
33
34
35 Part 4 – State Modifications Add or subtract the following. Enter the distributive share amount of each modification for Indiana 
36 adjusted gross income. For nonresidents, apply apportioned figures. (Use a minus sign to denote negative amounts.)
37
38 1.  State income taxes deducted _____________________________________________________                1  99999999999.00
39
40 2.  Net bonus depreciation allowance _________________________________________________               2  99999999999.00
41
42 3.  Excess IRC Section 179 deduction ________________________________________________                3  99999999999.00
43
44 4.  Interest on U.S. obligations  ______________________________________________________             4  99999999999.00
45
46 5.  Add-back/Deduction  _________________________________________Code No.                     999    5  99999999999.00
47
48 6.  Add-back/Deduction  _________________________________________Code No.                     999    6  99999999999.00
49
50 7.  Add-back/Deduction  _________________________________________Code No.                     999    7  99999999999.00
51
52 8.  Total distributive share of modifications (see instructions)   ______________________________    8  99999999999.00
53
54 9.  Add Part 3, line 11, to Part 4, line 8. See instructions for reporting on Schedule PTET,  
55     Schedule Composite, and/or Schedule Composite-COR  ___________ Adjusted Gross Income              9 99999999999.00
56
57
58
59
60
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62                                     *24100000000*
63                                                       24100000000
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