Indiana Department of Revenue
                                                                             IT-6
                                                                             For Use of Tax Year 2023
                                                                             08/2022

  Blank for Extension Payments

                                                        Blank for Vouchers 1 - 4 

Cut on line before mailing

                                    IT-6                0920    
XXXXXBusinessNameXXXXXXXXXXXXX
XXXXXAddressLine1XXXXXXXXXXXXX
XXXXXAddressLine2XXXXXXXXXXXXX                          Printed Name of Officer              Title

                                    6
Federal ID Number         Due Date                      Signature of Officer                 Title
999 99 9999               99 99 9999
                                                        Date                    Daytime Phone
Voucher Number            Calendar or Fiscal Year Ending
9                         XXX 9999
                                                                                             Enter Total Tax Below

INDIANA DEPARTMENT OF REVENUE
P.O. BOX 6032
                                                                                                     .
INDIANAPOLIS, IN 46206-6032

                                    089999999999999990079999999999999999999