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04 SCHEDULE E                                      Indiana Department of Revenue
   Form IT-20/20S/20NP/IT-65
05 State Form 49105                     Apportionment of Income for Indiana
   (R21 / 8-22)
06                                                             AA                                         BB
07                          for Tax Year Beginning 99 99       2022 and Ending       99 99            9999
08
09 Name as shown on return                                                           B  Federal Employer Identification Number A
10
11 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                 9999999999
12 Each filing entity having income from sources both within and outside Indiana must complete an apportionment schedule except financial institutions 
13 and certain insurance companies that use a single receipts factor.  Interstate transportation entities must use Schedule E-7. Combined unitary filers 
14 must use the apportioning method (relative formula percentage) as outlined in Information Bulletin #12 and Tax Policy Directive #6. Omit cents;  
15 percents should be rounded two decimal places; read apportionment instructions.
16
17 Part I - Indiana Apportionment of Adjusted Gross Income
18 Sales/Receipts (less returns and allowances) 
19 Include all non-exempt apportioned gross business income. Do not use non-unitary partnership income of previously apportioned 
20 income that must be separately reported as allocated income.
21
22                                                 Column A                          Column B               Column C
23                                           Total Within Indiana                    Total Within and       Indiana 
24                                                                                   Outside Indiana        Percentage
25 Sales delivered or shipped  
26 to Indiana:
27  1. Shipped from within  
28     Indiana                               99999999999       .00
29
30  2. Shipped from outside  
31     Indiana                               99999999999.00
32
33 Sales shipped from Indiana to:
34  3. The United States  
35     government                            99999999999.00
36  4.  Purchasers in a state where  
37     the taxpayer is not subject to  
38     income tax (under P.L. 86-272) 
39     (for years beginning prior to         99999999999.00 
40     Jan. 1, 2016 only)
41 Other
42  5.  Interest & other receipts from  
43     extending credit attributed to  
44     Indiana                               99999999999.00
45  6.  Other gross business receipts  
46     not previously apportioned            99999999999.00
47  7.  Direct premiums and annuities  
48     received for insurance upon  
49     property or risks in Indiana          99999999999.00
50  8.  Total Receipts: Add column A  
51     receipts lines on 1A through  
52     7A and enter in line 8A. Enter  
53     all receipts on line 8B          8A   99999999999.00                       8B 99999999999      .00
54
55 Apportionment of income for  
56 Indiana:
57  9.  Apportionment Percentage:  
58     Divide line 8A by line 8B (insert as  
59     percent, not decimal)                                                                              9 999. 99              %
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04 Schedule E                                                                                                            Page 2
05 Part II - Business/Other Income Questionnaire
06 1.  List all business locations where the taxpayer has operations or partnership interests and indicate type of activities. This section 
07 must be completed - attach additional sheets if necessary.
08
09 City                                                       State         Nature of Business Activity
10
11         XXXXXXXXXXXXXXXXXXXX                                     XX      XXXXXXXXXXXXXXXXXXXXXXXXXXXX
12 Accepts                               Registered to                      Files Returns 
13 Orders?     X Yes X   No              Do Business?  X      Yes   X  No   in State?                     X      Yes   X No
14 Property in                                    Property in 
15 State Leased? X   Yes X  No                    State Owned?    X Yes   X No
16
17 City                                                       State         Nature of Business Activity
18
19         XXXXXXXXXXXXXXXXXXXX                                     XX      XXXXXXXXXXXXXXXXXXXXXXXXXXXX
20 Accepts                               Registered to                      Files Returns 
21 Orders?     X Yes X   No              Do Business?  X      Yes   X  No   in State?                     X      Yes   X No
22 Property in                                    Property in 
23 State Leased? X   Yes X  No                    State Owned?    X Yes   X No
24
25 City                                                       State       Nature of Business Activity
26
27         XXXXXXXXXXXXXXXXXXXX                                     XX      XXXXXXXXXXXXXXXXXXXXXXXXXXXX
28 Accepts                               Registered to                      Files Returns 
29 Orders?     X Yes X   No              Do Business?  X      Yes   X  No   in State?                     X      Yes   X No
30 Property in                                    Property in 
31 State Leased? X   Yes X  No                    State Owned?    X Yes   X No
32
33 City                                                       State         Nature of Business Activity
34
35         XXXXXXXXXXXXXXXXXXXX                                     XX      XXXXXXXXXXXXXXXXXXXXXXXXXXXX
36 Accepts                               Registered to                      Files Returns 
37 Orders?     X Yes X   No              Do Business?  X      Yes   X  No   in State?                     X      Yes   X No
38 Property in                                    Property in 
39 State Leased? X   Yes X  No                    State Owned?    X Yes   X No
40
41 2.  Briefly describe the nature of Indiana business activities, including the exact title and principal business activity of any partnership 
42 in which the taxpayer has an interest:
43
44 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
45 3.  Indicate any partnership in which you have a unitary or general partnership relationship:
46
47 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
48 4.  Briefly describe the nature of activities of sales personnel operating and soliciting business in Indiana:
49
50 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
51 5.  Do Indiana receipts for line 3A include all sales shipped from Indiana to (1) the U.S. government;  
52 or (2) locations where this taxpayer’s only activity in the state of the purchaser consists of the mere           1     2
53 solicitation of orders? If no, please explain.                                                                X   Yes X No  (a)
54
55 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
56 6.  List the source of any directly allocated income from partnerships, estates, and trusts not in the taxpayer’s apportioned tax base:
57
58 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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