Form                               Indiana Department of Revenue
 IN-PTET                            Pass Through Entity Tax Election                               2022
 State Form 57223
            (3-23)

Part One: Instructions

This form is to be completed by an eligible partnership or S Corporation electing to be subject to the Pass Through Entity Tax. Mail 
the completed form to Indiana Department of Revenue, Tax Policy Division MS 102, 100 N. Senate Ave., Rm N248, Indianapolis IN 
46204. Retain a signed copy of this form for your records as proof of your election.

Part Two: Entity Information

The pass-through entity must complete all information required. Also, see specific instructions for completion of the return and 
Schedule Composite/Composite-COR at www.in.gov/dor/tax-forms/ptet/.
Entity Name                                                                         Federal Employer Identification Number

Entity type (check one):
                            □ Partnership                          □ S Corporation

Taxable year of election (Enter start and end dates)
Start (MM/DD/2022)                                                 End (MM/DD/YYYY)

For resident direct owners only, the pass-through entity is computing the owners’ tax (check one): 

□ Before allocation and apportionment (i.e., the owner’s entire share is subject to tax).  
 
□ After allocation and apportionment (i.e., only the owner’s share of income apportioned/allocated to Indiana is subject to tax).
 
□ The entity has no resident direct partners or shareholders. 

Part Three: Attestation

The entity listed on this form elects to be subject to the Pass Through Entity Tax imposed under IC 6-3-2.1 for the taxable year.  
The election by the entity for the taxable year cannot be revoked.

The undersigned is an individual who is authorized to bind the entity listed on this form to be subject to Pass Through Entity Tax. 
 
Signature:  ______________________________  Date: _________________________________

Printed Name: ___________________________  Title: __________________________________

                                                    Mail this form to:

                                    Indiana Department of Revenue 
                                          Tax Policy Division, MS 102 
                                    100 N. Senate Avenue, Room N248 
                                                    Indianapolis, IN 46204