Motorsports Investment District Income - Entity

ISSUER’S name, street address, city or town, state, ZIP code    1. State Income
                                                                                                2024
                                                                                             Form IN-MSID-A
                                                                2. State income tax withheld    State Form 56966 
                                                                                                (R4 / 6-24)

ISSUER’S FEIN  RECIPIENT’S FEIN or SSN                          3. Indiana state ID number   4. Local income

RECIPIENT’S name, street address, city or town, state, ZIP code 5. Indiana county code       6. Local income tax withheld 

                                                                    CORRECTED (if checked)       VOID (if checked)

Form IN-MSID-A                                                                             Indiana Department of Revenue