Schedule              Indiana Department of Revenue                                                            Enclosure 
IN-PAT                Qualified Patents Exemption Schedule                              2023    Sequence No. 22
State Form 54084
(R16 / 9-23)

Part 1
Name of Corporation, Nonprofit Organization, or Individual            Check one
                                                                                     □ SSN     □ FEIN     □ PTIN
Enter NAICS Code*                                                     Enter ID Number

*Visit www.naics.com for a complete listing of business codes.

Part 2
Name of Patent                                                        Patent Filing Date

Description of Patent                                                 Number of Employees on Patent Filing Date

Part 3
(Column 1)            (Column 2)                                      (Column 3)               (Column 4)
Claiming Exemp-       Amount of Income from                           Multiply by       Amount of Exemption Claimed
tion for (List Tax    a Qualified Patent                           Percentage Allowed
Period Ending)
1st year  ______                                                      x 0.50
2nd year  ______                                                      x 0.50
3rd year  ______                                                      x 0.50
4th year  ______                                                      x 0.50
5th year  ______                                                      x 0.50
6th year  ______                                                      x 0.40
7th year  ______                                                      x 0.30
8th year  ______                                                      x 0.20
9th year  ______                                                      x 0.10
10th year  ______                                                     x 0.10

Enclose this schedule with Form IT-20, IT-20NP, IT-40, or IT-40PNR.

                      *24100000000*
                                                           24100000000

                            Instructions for Completing Schedule IN-PAT

Qualified Patents Exemption                                   Enter the Social Security number, Federal Employer 
Public Law 223-2007 SECTIONS 1, 2, and 11 amended             Identification Number, or Individual Taxpayer identification 
Indiana Code (IC) 6-3-1-3.5 and adds IC 6-3-2-21.7,           number.
effective Jan. 1, 2008. Income from qualified patents 
included in federal taxable income is exempt from the         Enter the North American Industry Classification System 
adjusted gross income of individuals, corporations, and       (NAICS) business code for the patent. You can find a listing 
insurance companies for taxable years beginning after Dec.  of all the NAICS codes at www.naics.com.
31, 2007.
                                                              This exemption applies only to utility patents issued under 35 
• A qualified patent is a utility patent or a plant patent    U.S.C. 101 and plant patents issued under 35 U.S.C. 161 for 
  issued after Dec. 31, 2007, for an invention resulting from inventions resulting from development processes conducted 
  a development process conducted in Indiana. The term        in Indiana. The exemption does not include design patents 
  does not include a design patent.                           issued under 35 U.S.C. 171.

• The exemption from income includes licensing fees           Part 2
  or other income received for the use of the patent,         Enter the name and filing date of the patent. Enter a 
  royalties received for the infringement, receipts           description of the patent. Enter the number of employees 
  from the sale of a qualified patent, or income from         the entity had on the patent filing date. To qualify for this 
  the taxpayer’s own use of the patent to produce the         exemption, the entity must have fewer than 500 employees. 
  claimed invention.
                                                              Part 3
Who Should File Schedule IN-PAT?                              Column 1. Fill in the tax years for which you are taking the 
Any individual Indiana resident, any corporation (including   qualified patents income exemption. The exemption can be 
affiliates) that has fewer than 500 employees and is          claimed for up to 10 years. 
domiciled in Indiana, and any nonprofit organization that 
is domiciled in Indiana should complete Schedule IN-PAT       Column 2. Enter the amount of income earned from the 
if they are subject to the adjusted gross income tax and      patent. 
they have income from a qualified patent. Schedule IN-PAT 
should be enclosed with your Indiana tax return (Form IT-     Column 3. Multiply the amount of income earned from 
40, Form IT-20, or Form IT-20NP).                             the patent by the corresponding percentage. For the first 
                                                              5 years, 50% of the amount of income received from the 
Carryforward Years                                            patent is exempt; the percentage declines by 10% each 
The exemption may not be claimed for more than 10 years.      year starting in the sixth year that the exemption is claimed. 
For the first 5 years, 50% of the amount of income received 
from the patent is exempt; the percentage declines by 10%     Column 4. Enter the amount of the exemption you are 
each year starting in the sixth year that the exemption is    claiming (Column 2 multiplied by Column 3). Enter this 
claimed. The total amount of exemptions a taxpayer can        amount on Form IT-20 (line 10), Form IT-20NP (line 4), 
claim in a taxable year may not exceed $5 million.            Form IT-40 Schedule 2 (under line 11), or Form IT-40PNR 
                                                              Schedule C (under line 11). The total amount of exemptions 
For more information, get Income Tax Information Bulletin     claimed in a taxable year may not exceed $5 million.
#104 at www.in.gov/dor/files/reference/ib104.pdf.
                                                              Enclose this schedule with your Indiana tax return. 
Part 1
Enter the name of the individual, corporation, or nonprofit 
organization claiming the exemption. 

                                     *24100000000*
                                                      24100000000