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04 Schedule PTET                                   Indiana Department of Revenue
   State Form 57284
05 (8-23)                    Pass Through Entity Tax Return
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07 Check box if no Schedule Composite tax is due (see instructions)                Computation Code
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09 Check box if no Schedule Composite-COR tax is due (see instructions)
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11 Entity’s Tax Year 2023 or Other Year Beginning                   2023 and Ending
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13 Name of Entity                                                                                  Federal Employer Identification Number
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16 See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
17                                                  State of              Entity   Adjusted                                                                          Pass Through 
18                                                  Residency             Type     Gross Income                                                                      Entity Tax
19                                                  A                     B                        C                                                                 D
20                                                  Enter the       Enter the      Adjusted gross income attributed  Multiply C by the 
21                                                  2-character     entity type    to Indiana from IT-20S/IT-65                                                      individual tax rate 
22 Individual’s Social Security Number or Corporate state of                       IN K-1, Part 4, Line 9, or IT-41                                                  (.0315; .0305 for 
23 Entity’s Federal Employer Identification Number  residency                      IN K-1,Part 4, line 9                                                             years ending in 2024)

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56 22. Subtotal Column D ............................................................................................................................................
57 23. Carryover totals from Column D from additional sheets ....................................................................................
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59 24. Total tax (22D + 23D). Enter this amount on line 16 of Form IT-20S;
60    line 6c of Form IT-65; or, on Form IT-41, Schedule 1, line 3.. ........................................................... Total Tax
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62                           *24100000000*
63                                                            24100000000
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