Schedule PTET                                   Indiana Department of Revenue
State Form 57284
(8-23)                    Pass Through Entity Tax Return

Check box if no Schedule Composite tax is due (see instructions)                Computation Code

Check box if no Schedule Composite-COR tax is due (see instructions)

Entity’s Tax Year 2023 or Other Year Beginning                   2023 and Ending

Name of Entity                                                                                  Federal Employer Identification Number

See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
                                                 State of              Entity   Adjusted                                                                          Pass Through 
                                                 Residency             Type     Gross Income                                                                      Entity Tax
                                                 A                     B                        C                                                                 D
                                                 Enter the       Enter the      Adjusted gross income attributed  Multiply C by the 
                                                 2-character     entity type    to Indiana from IT-20S/IT-65                                                      individual tax rate 
Individual’s Social Security Number or Corporate state of                       IN K-1, Part 4, Line 9, or IT-41                                                  (.0315; .0305 for 
Entity’s Federal Employer Identification Number  residency                      IN K-1,Part 4, line 9                                                             years ending in 2024)

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

                          *24100000000*
                                                           24100000000