IT-41 Indiana Department of Revenue
2023 Schedule IN K-1
State Form 55891 Beneficiary’s Share of Indiana Adjusted Gross Income, 
(R10 / 8-23)
Deductions, Modifications, and Credits

 Tax Year Beginning and Ending

Name of Trust or Estate Federal Employer Identification Number

Amended IN K-1 Final IN K-1 Nonresident Beneficiary
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nnPart 1 – Identification and Distribution Information
Provide a copy of this Schedule IN K-1 reflecting the beneficiary’s share of income, deductions, and credits to each beneficiary. Enclose 
a copy of each Schedule IN K-1 with the Form IT-41 return when filing. 
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elle1. Beneficiary’s Name
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  l2. Beneficiary’s FEIN or Social Security Number 3. Beneficiary’s Address

4. Beneficiary’s City 5. Beneficiary’s State 6. Beneficiary’s ZIP Code

7. Beneficiary’s Federal Pro Rata Percentage 8. Indiana County of Principal Employment 2-digit code

. %
9. Payer’s Name 10. Payer’s FEIN
 IN K-1s must fil IN K-1s must fi
 9 9
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11.  Pass Through Entity Tax_________________________________________________________ 11 .00
 tha tha
ee12.  IN State Tax Withheld ___________________________________________________________ 12 .00

13.  IN County Tax Withheld  _________________________________________________________ 13 .00

ith morith morPart 2 - Pro Rata Share of Indiana Pass-through Tax Credits from Trust or Estate
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s s Column A Column B Column C Column D
ee IT-41 Federal ID Number Certification Certification/Project/PIN Tax Credit Column E
if Credit Is from IN K-1 Year Number Code Amount Claimed

1. .00
d Estatd Estat
nn2. .00

3. .00

4. .00

Trusts aTrusts a5.  .00

*24100000000* 
24100000000

Part 3 - Distributive Share Amount (use the Indiana apportioned figures for the beneficiary)

1.  Interest income _______________________________________________________________                  1   .00

2.  Ordinary dividends ____________________________________________________________                  2   .00

3.  Net short-term capital gains  _____________________________________________________              3   .00

4.  Net long-term capital gains ______________________________________________________               4   .00

5.  Other portfolio and nonbusiness income  ___________________________________________              5   .00

6.  Ordinary business income  ______________________________________________________                 6   .00

7.  Net rental real estate income ____________________________________________________               7   .00

8.  Other rental income  ___________________________________________________________                 8   .00

9.  Directly apportioned deductions __________________________________________________               9   .00

10. Final year deductions __________________________________________________________                 10  .00

11. Total pro rata distributions (If lines 1-8 are positive, add them. If lines 1-8 are 
    negative, see instructions. Also see instructions for reporting lines 9 and 10.)  ______________ 11  .00

Part 4 - State Modifications Add or subtract the following. Enter the distributive share amount of each modification for Indiana adjusted 
gross income. For nonresidents, apply apportioned figures. (Use a minus sign to denote negative amounts.)

1.  State income taxes deducted _____________________________________________________                1   .00

2.  Net bonus depreciation allowance _________________________________________________               2   .00

3.  Excess IRC Section 179 deduction ________________________________________________                3   .00

4.  Interest on U.S. obligations  ______________________________________________________             4   .00

5.  Add-back/Deduction  ________________________________________ Code No.                            5   .00

6.  Add-back/Deduction  ________________________________________ Code No.                            6   .00

7.  Add-back/Deduction  ________________________________________ Code No.                            7   .00

8.  Total distributive share of modifications (see instructions)   ______________________________    8   .00

9.  Add Part 3, line 11, to Part 4, line 8. See instructions for reporting on Schedule PTET,  
    Schedule Composite, and/or Schedule Composite-COR  __________ Adjusted Gross Income               9  .00

                                    *24100000000*
                                                      24100000000