Schedule Composite                                           Indiana Department of Revenue
State Form 49188
(R21 / 8-22)                                                 Entity’s Composite Indiana 
                                                      Adjusted Gross Income Tax Return

Entity’s Tax Year 2022 or Other Year Beginning        2022 and Ending

Name of Entity                                                                                                                              Federal Employer Identification Number

See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
                                               Exception                State of        Enter Pro Rata                               Composite Adjusted Gross and 
                                               Code                     residency               Share                                       County Income Tax                                                     Total Tax
                                                      A                 B                       C                              D                   E                                                     F        G
                                               Enter                    Enter the       Adjusted gross                   State Tax.         Income              County tax.                                       Enter partner/
                                               exception code           2-character     income attributed                Multiply C by      subject to county   Multiply E by                                     shareholder/
                                               (see                     state of        to Indiana from                  .0323 (leave       tax from IN K-1,    county tax rate                                   beneficiary tax 
                                               instructions)            residency       IT-20S/IT-65 IN                  blank if less than Part 1, line 12, or (leave blank if                                   liability (D + F)
                                                                        for each non-   K-1, Part 4, Line                zero)              IT-41 IN K-1, Part  less than zero)
Individual / Non-Corporate                                              resident listed 9, or IT-41 IN K-1,                                 1, line 13
Entity Name                                                                             Part 4, line 9
 1.
 2.
 3.
 4.
 5.
 6.
 7. 
 8.
 9.
10.
11.
12.
13. Subtotal Column D and Column F; add together and enter total in Column G ...................................
14. Carryover totals from Columns D, F, and G from additional sheets ....................................................
15. Total tax (13G + 14G). Enter this amount on line 15 of Form IT-20S; 
    line 6a of Form IT-65; or, on Form IT-41, Schedule 1, line 2.........................................................................................................................................Total Tax
                                                      *24100000000*
                                                                                  24100000000