Column I Addback Amount

Column H
Amount Paid

)(,1 RI ¿OLQJ HQWLW\
Code
Column G Exception 

Code
Column F (P, S, or B)
Relationship 

Column E State or 
and Ending Country of Domicile

24100000000
Column D
Recipient FEIN
Indiana Department of Revenue

Column C
Recipient Name

For Tax Year Beginning 
Disclosure of Intangible Expense and Directly Related Interest Expense

FEIN
Column B
Paying Entity 

(R14 / 8-19) /LVW WUDQVDFWLRQV PDGH ZLWK HYHU\ UHFLSLHQW IRU UR\DOWLHV  SDWHQWV  FRS\ULJKWV  HWF Column A
State Form 53126   
Paying Entity Name
Schedule IT-20PIC  Enter name of corporation as shown on return Part 1 – Transactions Involving Intangible Property with a Related Party                          7RWDO &ROXPQ +     7RWDO &ROXPQ ,  &DUU\ WKLV DPRXQW WR OLQHV   WKURXJK    RQ )RUP ,7    DQG XVH FRGH    

                                                                                                                               Column I           Addback           Amount

                                                                                                                               Column H
                                                                                                                                                  Amount Paid

                                                                                                                                                                    Code
                                                                                                                               Column G           Exception 

                                                                                                                                                                    Code
                                                                                                                               Column F                                        (P, S, or B)
                                                                                                                                                  Relationship 

                                                                                                                               Column E           State or                     Domicile
                                                                                                                                                                    Country of 

                                                                                                                                                                                                                                                                                                                                                                                                                                                       24100000000
                                                                                                                               Column D
                                                                                                                                                  Recipient FEIN

                                                                                                                               Column C
                                                                                                                                                  Recipient Name

                                                                                                                                                                    FEIN
                                                                                                                               Column B
                                                                                                                                                  Paying Entity 

                                                              /LVW WUDQVDFWLRQV PDGH ZLWK HYHU\ UHFLSLHQW IRU LQWHUHVW         Column A

                                                                                                                                                  Paying Entity Name
Part 2 – Transactions Involving Interest with a Related Party                                                                                                                                                                          7RWDO &ROXPQ +                                                                                               7RWDO &ROXPQ ,  &DUU\ WKLV DPRXQW WR OLQHV   WKURXJK    RQ )RUP ,7    DQG XVH FRGH