01
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04   Schedule IN-W                     Indiana Department of Revenue                                             Enclosure 
                                                                                                Sequence No. 26
05   Form IT-40, IT-40PNR, IT-40RNR    Indiana Withholding Statements
     State Form 53056 (R2 / 9-24)                                                           2024
06
07 Name(s) shown on Form IT-40/IT-40PNR/IT-40RNR                                     Your Social Security Number
08
09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                   999    99  9999
10
11   A         B                  C              D                       E           F          G                H 
12   Social Security  Form Employer or           State          State Tax            Local      Local Tax        Locality 
     Number    Code Payer ID Number    Income                   Withheld             Income     Withheld         Code
13
14 1
     9999999999999999999999999999999999009999999900999999999990099999999009999
15 2
                                                                009999999900999999999990099999999009999
16   9999999999999999999999999999999999
17 3
     9999999999999999999999999999999999009999999900999999999990099999999009999
18 4
                                                                009999999900999999999990099999999009999
19   9999999999999999999999999999999999
20 5
     9999999999999999999999999999999999009999999900999999999990099999999009999
21 6
                                                                009999999900999999999990099999999009999
22   9999999999999999999999999999999999
23 7
     9999999999999999999999999999999999009999999900999999999990099999999009999
24 8
                                                                009999999900999999999990099999999009999
25   9999999999999999999999999999999999
26 9
     9999999999999999999999999999999999009999999900999999999990099999999009999
27 10
                                                                009999999900999999999990099999999009999
28   9999999999999999999999999999999999
29 11
     9999999999999999999999999999999999009999999900999999999990099999999009999
30 12
                                                                009999999900999999999990099999999009999
31   9999999999999999999999999999999999
32 13
     9999999999999999999999999999999999009999999900999999999990099999999009999
33 14
                                                                009999999900999999999990099999999009999
34   9999999999999999999999999999999999
35 15
     9999999999999999999999999999999999009999999900999999999990099999999009999
36 16
                                                                009999999900999999999990099999999009999
37   9999999999999999999999999999999999
38 17
     9999999999999999999999999999999999009999999900999999999990099999999009999
39 18
                                                                009999999900999999999990099999999009999
40   9999999999999999999999999999999999
41 19
     9999999999999999999999999999999999009999999900999999999990099999999009999
42 20
                                                                009999999900999999999990099999999009999
43   9999999999999999999999999999999999
44 21
     9999999999999999999999999999999999009999999900999999999990099999999009999
45 22
                                                                009999999900999999999990099999999009999
46   9999999999999999999999999999999999
47 23
     9999999999999999999999999999999999009999999900999999999990099999999009999
48 24
                                                                009999999900999999999990099999999009999
49   9999999999999999999999999999999999
50 25
     9999999999999999999999999999999999009999999900999999999990099999999009999
51   Add lines 1 through 25 column E. Enter total on line 1 of  
52 26 IT-40 Schedule 5, or line 1 of IT-40PNR Schedule F, or  
     line 7 of IT-40RNR.                                                   00
53                                                              9999999999
     Add lines 1 through 25 column G. Enter total on line 2 of IT-40 Schedule 5, or  
54 27
     line 2 of IT-40PNR Schedule F, or line 8 of IT-40RNR.
55                                                                                          999999999900
56
57                                     Schedule IN-W Reference Chart
58   Form Type             Form Code   Form Type                Form Code            Form Type  Form Code
59   W2/W2C                       W    1099R                             R           1099G                      U
60   W2G                          G    1099M                             M           1099NEC                    N
61
62                                     *26124111694*
63                                                            26124111694
64
65
66