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04 Schedule Composite                                          Indiana Department of Revenue
   State Form 49188
05 (R22 / 8-23)                                               Entity’s Composite Indiana 
06                                                          Adjusted Gross Income Tax Return
07
08
   Entity’s Tax Year 2023 or Other Year Beginning           2023 and Ending
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11 Name of Entity                                                                                                                                   Federal Employer Identification Number
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14 See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
15                                                   Exception             State of        Enter Pro Rata                         Composite Adjusted Gross, Pass Through Entity, 
16                                                   Code                  residency               Share                                          and County Income Tax                                                 Total Tax
17                                                          A              B                       C                              D                 E                                                          F        G
18                                                   Enter                 Enter the       Adjusted gross                         State Tax.        Pass Through      County tax.                                       Enter partner/
                                                     exception code        2-character     income attributed                      Multiply C by     Entity Tax (Enter (see instructions)                                shareholder/
19                                                   (see instructions)    state of        to Indiana from                        .0315 (.0305 for  total amount from                                                   beneficiary tax 
20                                                                         residency       IT-20S/IT-65 IN                        years ending in   Schedule PTET)                                                      liability (D - E + F) 
                                                                           for each non-   K-1, Part 4, Line                      2024; leave blank                                                                     (If E > D, enter F. 
21 Individual / Non-Corporate Entity Social Security                       resident listed 9, or IT-41 IN K-1,  if less than zero)                                                                                      Leave blank if  
22 Number or Federal Employer Identification Number                                        Part 4, line 9                                                                                                               less than zero.)
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42 13. Subtotal Column D, Column E, Column F, and Column G .......................................................................
43 14. Carryover totals from Columns D, E, F, and G from additional sheets.....................................................
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   15. Total tax (13G + 14G). Enter this amount on line 15 of Form IT-20S; 
45     line 6a of Form IT-65; or, on Form IT-41, Schedule 1, line 2. ......................................................................................................................................... Total Tax
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47                                                          *24100000000*
48                                                                                   24100000000
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