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04 Form IT-65                                              Indiana Department of Revenue
   State Form 11800 
05 (R22 / 8-23)                                     Indiana Partnership Return                                     2023
06                                            for Calendar Year Ending December  31, 2023
07
08                    or  Other Tax Year Beginning         99    99         2023 and Ending     99 99        9999
09
10 Check box if amended.                    X Check box if amendment is due to a federal audit. X            Check box if name changed. X
11 Name of Partnership                                                                          Federal Employer Identification Number
12
13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                            9999999999
14 Number and Street                                       Principal Business Activity Code Foreign Country 2-Character Code
15
16   XXXXXXXXXXXXXXXXXXXXXXXXXXX                                     99999999                                XX
17 City                                                       State              ZIP Code             2-Digit County Code
18
19         XXXXXXXXXXXXXXXXXXXX                                       XX         999999999                   XX              M. Year of initial 
20 Telephone Number                   K. Date of organization           In the State of  L. State of commercial domicile     Indiana return
21
22       9999999999                   99            99     9999             XX                       XX                          9999
23
24 N. Accounting method: Cash X               Accrual X    Other X          T. Check box if claiming a credit on Form IT-20REC    X
25
26 O. Check all boxes that apply to entity:
27
28   Initial Return X  Final Return           X         In Bankruptcy   X        Composite Return  X         PTET Return    X
29
30 P. Enter total number of partners: 9999                 Enter number of nonresident partners:   9999
31
32 Q. I have on file a valid extension of time to file my return (federal Form 7004 or an electronic extension of time).  X  
33
34 R. This partnership is a member of another partnership(s). X         S. This entity reports income from disregarded entities. X
35
36 Aggregate Partnership Distributive Share Income (see worksheet)                                                 Round all entries
37   1.  Total net income (loss) from U.S. partnership return, Form 1065 Schedule K (see instructions);  
38      use minus sign for negative amounts ______________________________________________                   1  99999999999.00
39
40   2.  a. Enter name of addback or deduction (see instructions)    XXXXXXXX    Code. No.        999        2a    99999999999.00 
41
42      b. Enter name of addback or deduction       XXXXXXXXXXXXXXXXXX           Code. No.        999        2b    99999999999.00 
43
44      c. Enter name of addback or deduction       XXXXXXXXXXXXXXXXXX           Code. No.        999        2c    99999999999.00 
45      d. Enter the total amount of addbacks and deductions from any additional sheets (use a 
46         minus sign for negative amount) ________________________________________________                  2d    99999999999.00
47
48   3.  Total partnership income, as adjusted (add lines 1 through 2d) __________________________           3     99999999999.00
49   4.  Enter percentage for Indiana apportioned adjusted gross income from IT-65 Schedule E line 9,  
50      if applicable __________________________________________________________________                     4     999. 99               %
51 Summary of Calculations
52   5.  Sales/use tax due on purchases subject to use tax from Sales/Use Tax worksheet  __________          5     99999999999.00
53   6.  a. Enter amount from line 15G of completed 
54         Schedule Composite  ____________________________                 6a   99999999999.00
55      b. Enter amount from line 26E of completed 
56         Schedule Composite-COR ________________________                  6b   99999999999.00
57      c. Enter amount from line 24D of completed
58         Schedule PTET  ________________________________                  6c   99999999999.00
59      d. Add amounts from lines 6a - 6c. Attach Schedule Schedule Composite/Composite-COR/PTET _           6d    99999999999.00
60
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05
06
07 7.  Total tax (add lines 5 and 6d). Caution:  If line 7 is zero, see line 16 late file penalty __________  7     99999999999.00
08
09 8.  Total amount of pass-through withholding and PTET (enclose IN K-1 from the paying entity) ___          8     99999999999.00
10
11 9.  Total composite withholding IT-6WTH payments (see instructions) _______________________                9     99999999999.00
12
13 10.  Other payments/credits (enclose documentation)  ____________________________________                  10    99999999999.00
14
15 11.  EDGE credit. Enter the total EDGE credit amount claimed (line 19 on Schedule IN-EDGE) ____            11    99999999999.00
16
17 12.  EDGE-R credit. Enter the total EDGE-R credit amount claimed (line 19 on Schedule IN-EDGE-R)  12             99999999999.00
18 13.  Certified Credits. Enter the total of certified credits claimed from Schedule IN-OCC and enclose  
19     this schedule with your return. ___________________________________________________                    13    99999999999.00
20
21 14. Subtotal (line 7 minus lines 8-13). If total is greater than zero, proceed to lines 15-17 ________     14    99999999999.00
22
23 15.  Interest: Enter total interest due; see instructions (contact the department for current interest rate)  15 99999999999.00
24 16. Penalty: If paying late, enter 10% of line 14. If line 7 is zero, enter $10 per day filed past the  
25     due date; see instructions _______________________________________________________                     16    99999999999.00
26 17. Total Amount Due (add lines 14-16). If less than zero, enter on line 18.  
27     Make payment in U.S. funds _____________________________________________________                       17    99999999999.00
28 18. Overpayment and Refund Amount (add lines 8-13, and then subtract lines 7, 15, and 16).
29     No carryforward allowed.  _______________________________________________________                      18    99999999999.00
30
31
32 Certification of Signatures and Authorization Section
   Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to the best 
33 of my knowledge and belief it is true, correct, and complete.
34
35 Signature                                                       Paid Preparer’s 
36                                                                 Email Address                 XXXXXXXXXXXXXXXXXXXXXX
37
38    I authorize the Department to discuss my return with my      Paid Preparer: Firm’s Name (or yours if self-employed)
39    personal representative (see instructions).
40                                                                 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
41     Y X          N X    Date ____________________________       Paid Preparer’s Name
42
43    Personal Representative’s Name (please print)                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
44
45    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                          PTIN          999999999
46    Email
47    Address                                                      Telephone Number                        9999999999
48           999999999999999999999999999999
49    Signature of                                                 Address XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
50    Corporate Officer __________________________________
51                                                                 City          XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
52    Print or Type Name of Corporate Officer
53                                                                 State           XX                      ZIP Code+4 999999999
54    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
55    Title                                                        Paid Preparer’s Signature ____________________________
56
57    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                           Date _____________________________________________
58
59     If you owe tax, please mail your return to IN Department of If you do not owe any tax, mail it to IN Department of Revenue, 
60       Revenue, PO Box 7205, Indianapolis, IN 46207-7205.                      PO Box 7147, Indianapolis, IN 46207-7147.
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