IT-41                                                                                                             Indiana Department of Revenue
2024 Schedule IN K-1                                                                    Beneficiary’s Share of Indiana Adjusted Gross Income, 
State Form 55891 
(R11 / 8-24)                                                                                     Deductions, Modifications, and Credits

                                                                                        Tax Year Beginning                           and Ending

Name of Trust or Estate                                                                                                                                  Federal Employer Identification Number

Amended IN K-1                                                                          Final IN K-1                     Nonresident Beneficiary

Part 1 – Identification and Distribution Information
Provide a copy of this Schedule IN K-1 reflecting the beneficiary’s share of income, deductions, and credits to each beneficiary.  
Enclose a copy of each Schedule IN K-1 with the Form IT-41 return when filing. 

1.                                                                   Beneficiary’s Name

2.                                                                   Beneficiary’s FEIN or Social Security Number         3. Beneficiary’s Address

4.                                                                   Beneficiary’s City                                   5. Beneficiary’s State     6. Beneficiary’s ZIP Code

7.                                                                   Beneficiary’s Federal Pro Rata Percentage            8. Indiana County of Principal Employment 2-digit code

                                                                        . %
9.                                                                   Payer’s Name                                                                    10. Payer’s FEIN

11.  Pass Through Entity Tax_________________________________________________________                                                                            11                .00

12.  IN State Tax Withheld ___________________________________________________________                                                                           12                .00

13.  IN County Tax Withheld  _________________________________________________________                                                                           13                .00

Part 2 – Pro Rata Share of Indiana Pass-through Tax Credits from Trust or Estate

                                                                          Column A                         Column B       Column C                   Column D 
                                                                        IT-41 Federal ID Number            Certification  Certification/Project/PIN  Tax Credit      Column E 
                                                                        if Credit is from IN K-1           Year           Number                         Code        Amount Claimed

                                                                     1.                                                                                                            .00

                                                                     2.                                                                                                            .00

                                                                     3.                                                                                                            .00

Trusts and Estates with more than 9 IN K-1s must file electronically 4.                                                                                                            .00

                                                                     5.                                                                                                            .00

                                                                                                           *24100000000*
                                                                                                                          24100000000

Part 3 – Distributive Share Amount (use the Indiana apportioned figures for the beneficiary)

1.  Interest income ________________________________________________________________                 1                           .00

2.  Ordinary dividends _____________________________________________________________                 2                           .00

3.  Net short-term capital gains   _____________________________________________________             3                           .00

4.  Net long-term capital gains _______________________________________________________              4                           .00

5.  Other portfolio and nonbusiness income ____________________________________________              5                           .00

6.  Ordinary business income _______________________________________________________                 6                           .00

7.  Net rental real estate income _____________________________________________________              7                           .00

8.  Other rental income ____________________________________________________________                 8                           .00

9.  Directly apportioned deductions ___________________________________________________              9                           .00

10. Final year deductions ___________________________________________________________                10                          .00

11. Total pro rata distributions (If lines 1-8 are positive, add them. If lines 1-8 are 
    negative, see instructions. Also see instructions for reporting lines 9 and 10.) _______________ 11                          .00

Part 4 – State Modifications Add or subtract the following. Enter the distributive share amount of each modification for Indiana 
adjusted gross income. For nonresidents, apply apportioned figures. (Use a minus sign to denote negative amounts.)

1.  State income taxes deducted _____________________________________________________                1                           .00

2.  Net bonus depreciation allowance _________________________________________________               2                           .00

3.  Excess IRC Section 179 deduction ________________________________________________                3                           .00

4.  Interest on U.S. obligations  ______________________________________________________             4                           .00

5.  Add-back/Deduction  _________________________________________Code No.                            5                           .00

6.  Add-back/Deduction  _________________________________________Code No.                            6                           .00

7.  Add-back/Deduction  _________________________________________Code No.                            7                           .00

8.  Total distributive share of modifications (see instructions)   ______________________________    8                           .00

9.  Add Part 3, line 11, to Part 4, line 8. See instructions for reporting on Schedule PTET,  
    Schedule Composite, and/or Schedule Composite-COR  ___________ Adjusted Gross Income              9                          .00

                                    *24100000000*
                                                      24100000000