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04                                                                                                                                                                                                                     IT-20S/IT-65                                    Indiana Department of Revenue
                                                                                                                                                                                                                       2023 Schedule IN K-1
05                                                                                                                                                                                                                     State Form 49181         Shareholder’s/Partner’s Share of Indiana Adjusted Gross 
                                                                                                                                                                                                                       (R23 / 8-23)
06                                                                                                                                                                                                                                                  Income, Deductions, Modifications, and Credits
07
08                                                                                                                                                                                                                                                  Tax Year Beginning 99    99            2023 and Ending 99 99      9999
09
10                                                                                                                                                                                                                     Name of S Corporation/Partnership                                                   Federal Employer Identification Number
11
12                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                          9999999999
13
14                                                                                                                                                                                                                     Distributions - Provide Schedule IN K-1 to each shareholder/partner. Enclose Schedule IN K-1 with Form IT-20S/IT-65 return. 
15
16                                                                                                                                                                                                                     Part 1 – Shareholder/Partner’s Identification Section
17                                                                                                                                                                                                                     1. Shareholder/Partner Name
18
19                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Check if amended                              X
20                                                                                                            le electronically le electronically                                                                      2. Shareholder/Partner FEIN or Social Security Number               3. Shareholder/Partner Federal Pro Rata Percentage
21                                                                                                           fifi
                                                                                                                                                                                                                                                                                                                 %
22                                                                                                                                                                                                                         9999999999                                                               999. 99
23                                                                                                                                                                                                                     4. If the partner is a disregarded entity (DE), enter the partner’s:
24                                                                                                                                                                                                                       a. Name                                                                           b. FEIN
25
26                                                                                                                                                                                                                      XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                   9999999999
27                                                                                                                                                                                                                     5. What type of entity is the partner?
28
29                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
30                                                                                                                                                                                                                     6. Shareholder/Partner State of Residence or Commercial Domicile    7. Indiana County of Principal Employment 2-digit code
31
32                                                                                                                                                                                                                         XX                                                                       XX
33                                                                                                                                                                                                                     8. Payer’s Name                                                                     9. Payer’s FEIN
34
35                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                         9999999999
36
37                                                                                                                                                                                                                     10. Pass Through Entity Tax _________________________________________________________   10         99999999999.00
38
39                                                                                                                                                                                                                     11. IN State Tax Withheld  ___________________________________________________________   11        99999999999.00 
40
41                                                                                                                                                                                                                     12. IN County Tax Withheld  _________________________________________________________   12         99999999999.00
42
43
44
45                                                                                                                                                                                                                     Part 2 - Pro Rata Share of Indiana Pass-through Tax Credits from S Corporation/Partnership
46
47                                                                                                                                                                                                                                      Column A             Column B                      Column C        Column D
48                                                                                                                                                                                                                                      IT-20S/IT65          Certification   Certification/Project/PIN     Tax Credit     Column E
49                                                                                                                                                                                                                         FEIN if Credit is from IN K-1     Year                          Number             Code        Amount Claimed
50
51                                                                                                                                                                                                                     1.          9999999999                9999            9999999999999999                 9999        99999999999.00
52
53                                                                                                                                                                                                                     2.          9999999999                9999            9999999999999999                 9999        99999999999.00
54
55                                                                                                                                                                                                                     3.          9999999999                9999            9999999999999999                 9999        99999999999.00
56
57                                                                                                           Pass-through entities with more than 24 IN K-1s must Pass-through entities with more than 24 IN K-1s must 4.          9999999999                9999            9999999999999999                 9999        99999999999.00
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59
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62                                                                                                                                                                                                                                                           *24100000000*
63                                                                                                                                                                                                                                                                           24100000000
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04
05
06 Part 3 - Distributive Share Amount (use apportioned figures for nonresident shareholders/partners)
07  1.  Ordinary business income (loss)  _________________________________________________               1    99999999999.00
08
09  2.  Net rental real estate income (loss) _______________________________________________             2    99999999999.00
10
11  3.  Other net rental income (loss)  ___________________________________________________              3    99999999999.00
12
13  4. Guaranteed payments (for IT-65 filers only; if filing IT-20S, skip to line 5)   ______________    4    99999999999.00
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15  5.  Interest income _______________________________________________________________                  5    99999999999.00
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17  6. Ordinary dividends ____________________________________________________________                   6    99999999999.00
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19  7. Royalties ____________________________________________________________________                    7    99999999999.00
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21  8.  Net short-term capital gain (loss) _________________________________________________             8    99999999999.00
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23  9.  Net long-term capital gain (loss)  _________________________________________________             9    99999999999.00
24
25 10.  Net IRC Section 1231 gain (loss) _________________________________________________               10   99999999999.00
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27 11.  Other income (loss)  ___________________________________________________________                 11   99999999999.00
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29 12.  IRC Section 179 expense deduction  ______________________________________________                12   99999999999.00
30
31 13.  a. Portion of expenses related to investment portfolio income, including investment interest 
32     expense and other (federal nonitemized) deductions (see instructions)  _________________   13a         99999999999.00
33
34     b. Other information from line 20 of federal K-1 related to investment interest and expenses not 
35     listed elsewhere (see instructions) ______________________________________________                 13b 99999999999.00
36 14.  Total pro rata distributions. Add all positive amounts on lines 1 through 11. See instructions  
37     for lines 12, 13a, 13b, and if you reported negative amounts on lines 1 through 11. __________    14   99999999999.00
38
39 Part 4 - State Modifications  Add or subtract the following. Designate the distributive share amount of each modification for Indiana 
40 adjusted gross income from line 2 on the front of Form IT-20S/IT-65. For nonresidents, apply apportioned figures. (Use a minus sign to 
41 denote negative amounts.)
42 1.  State income taxes deducted ____________________________________________________                  1    99999999999.00
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44 2.  Net bonus depreciation allowance  ________________________________________________                2    99999999999.00
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46 3.  Excess IRC Section 179 deduction  _______________________________________________                 3    99999999999.00
47
48 4.  Interest on U.S. obligations ______________________________________________________               4    99999999999.00
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50 5.  Addback/Deduction _________________________________________    Code No.                   999     5    99999999999.00
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52 6.  Addback/Deduction _________________________________________    Code No.                   999     6    99999999999.00
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54 7.  Addback/Deduction _________________________________________    Code No.                   999     7    99999999999.00
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56 8.  Total distributive share of modifications (see instructions) ______________________________       8    99999999999.00
57
58 9.  Add Part 3, line 14, to Part 4, line 8. See instructions for reporting on Schedule PTET,  
59     Schedule Composite, and/or Schedule Composite-COR.  __________ Adjusted Gross Income              9    99999999999.00
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62                                          *24100000000*
63                                          24100000000
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