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04            Form IT-40PNR                               Indiana Department of Revenue
              State Form 472 
05            (R23 / 9-24)                 Indiana Part-Year or Full-Year Nonresident 
06                                                 Individual Income Tax Return                                 2024
07                                                                 Due April 15, 2025
08                                 If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY):
09
10                                 from        99       99         9999       to:   99     99   9999
11                                                                                                                   Place “X” in box 
12 Place “X” in box if you are applying for ITIN. X        Place “X” in box if spouse is applying for ITIN. X        if amending.           X
13 Your Social                                             Spouse’s Social                                      Place “X” in box if you are 
14 Security Number      999        99          9999        Security Number        999      99   9999            married filing separately.  X
15 Your first name                                      Initial    Last name                                           Suffix
16
17  XXXXXXXXXXXXXXX                                       X        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                         XXXXX
18 If filing a joint return, spouse’s first name        Initial    Last name                                           Suffix
19
20  XXXXXXXXXXXXXXX                                       X        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                         XXXXX
21 Present address (number and street or rural route) 
22
23  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                              Foreign country 2-character 
24 City                                                                      State        ZIP/Postal code       code (see instructions) 
25
26  XXXXXXXXXXXXXXXXXXXX                                                      XX           9999999999              XX
27
28 Enter below the 2-digit county code numbers (found on the back of Schedule CT-40PNR) for the county where you lived and 
29 worked on Jan. 1, 2024.    
30 County where                    County where                              County where          County where 
31 you lived            99         you worked      99                        spouse lived  99      spouse worked     99
32
33                                                                                                                 Round all entries
34  1.  Complete Schedule A first. Enter here the amount from Section 3,  
35      line 36B, and enclose Schedule A    _____________________________________          Indiana Income    1     99999999999.00
36
37  2.  Enter amount from Schedule B, line 6, and enclose Schedule B ___________           Indiana Add-Backs 2     99999999999.00
38
39  3.  Add line 1 and line 2 _____________________________________________________________                  3     99999999999.00
40
41  4.  Enter amount from Schedule C, line 12, and enclose Schedule C           ________Indiana Deductions   4     99999999999.00
42
43  5.  Subtract line 4 from line 3 _________________________________________________________                5     99999999999.00
44
45  6.  You must complete Schedule D. Enter amount from Schedule D, line 9,  
46      and enclose Schedule D      ________________________________________Indiana Exemptions               6     99999999999.00
47
48  7.  Subtract line 6 from line 5 ______________________________Indiana Adjusted Gross Income              7     99999999999.00
49  8.  State adjusted gross income tax: multiply line 7 by 3.05% (.0305) 
50      (if answer is less than zero, leave blank) __________________             8 99999999999.00
51  9.  County tax. Enter county tax due from Schedule CT-40PNR 
52      (if answer is less than zero, leave blank) __________________         9     99999999999.00
53
54 10.  Other taxes. Enter amount from Schedule E, line 5 (enclose sch.)   10       99999999999.00
55
56 11.  Add lines 8, 9 and 10. Enter total here and on line 15 on the back _____________ Indiana Taxes          11 99999999999.00
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05 12.  Enter credits from Schedule F, line 13 (enclose schedule)  ____   12    99999999999.00
06
07 13.  Enter offset credits from Schedule G, line 8 (enclose schedule) __   13 99999999999.00
08
09 14.  Add lines 12 and 13  ________________________________________________ Indiana Credits                       14 99999999999.00
10
11 15.  Enter amount from line 11  ____________________________________________ Indiana Taxes                       15 99999999999.00
12
13 16.  If line 14 is equal to or more than line 15, subtract line 15 from line 14 (if smaller, skip to line 23) _  16 99999999999.00
14
15 17.  Enter donations from Schedule IN-DONATE (enclose schedule); cannot be greater than line 16 ___              17 99999999999.00
16
17 18.  Subtract line 17 from line 16 ___________________________________________               Overpayment         18 99999999999.00
18
19 19.  Amount from line 18 to be applied to your 2025 estimated tax account (see instructions).
20
21     a.  Enter your county code    99 county tax to be applied ____  19a      99999999999.00
22
23     a.  Spouse’s county code      99 county tax to be applied ____  19b      99999999999.00
24
25     b.  Indiana adjusted gross income tax to be applied ________  19c        99999999999.00
26
27     c.  Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18) ___   19d        99999999999.00
28
29 20.  Penalty for underpayment of estimated tax from Schedule IT-2210 and IT-2210A  _____________                 20 99999999999.00
30
31     a.  Enter code A if annualizing. Enter Code F if farmer or fisherman   __________          20a X
32
33 21. Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 instructions _ Your Refund      21 99999999999.00
34
35 22. Direct Deposit (see instructions)
36
37     a.  Routing Number   9 9 9 9 9 9 9 9 9
38
39     b.  Account Number   9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
40
41     c.  Type:  X  Checking        X  Savings X          Hoosier Works MC
42
43     d.  Place an “X” in the box if refund will go to an account outside the United States.      X
44
45 23.  If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on line 20 
46     (see instructions) _______________________________________________________________                           23 99999999999.00
47
48 24.  Penalty if filed after due date (see instructions) ________________________________________                 24 99999999999.00
49
50 25.  Interest if filed after due date (see instructions) ________________________________________                25 99999999999.00
51
52 26.  Amount Due: Add lines 23, 24 and 25 ________________________________ Amount You Owe                         26 99999999999.00 
53     Do not send cash. Please make your check or money order payable to:  
54     Indiana Department of Revenue. See instructions if paying by credit card.
55
   Sign and date this return after reading the Authorization statement on Schedule H. You must enclose Schedule H (both pages).
56
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58 Your Signature                               Date                       Spouse’s Signature                          Date
59 • If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224.
60 • Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.
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