Schedule IT-20PIC                                           Indiana Department of Revenue
    State Form 53126   
    (R14 / 8-19)       Disclosure of Intangible Expense and Directly Related Interest Expense

                            For Tax Year Beginning                                         and Ending

 Enter name of corporation as shown on return                                                                      FEIN of filing entity

Part 1 – Transactions Involving Intangible Property with a Related Party
    List transactions made with every recipient for royalties, patents, copyrights, etc.

    Column A           Column B               Column C                  Column D           Column E   Column F     Column G  Column H    Column I
   Paying Entity Name  Paying Entity          Recipient Name            Recipient FEIN     State or   Relationship Exception Amount Paid Addback 
                       FEIN                                                                Country of Code         Code                  Amount
                                                                                           Domicile   (P, S, or B)

 1.

 2.

 3.

 4.

 5.

 6.

 7.

 8.

 9.

 10.

 11. Total Column H

 12. Total Column I. Carry this amount to lines 4 through 10 on Form IT-20 and use code 140

                                                   *24100000000*
                                                                        24100000000

Part 2 – Transactions Involving Interest with a Related Party
   List transactions made with every recipient for interest

   Column A          Column B      Column C                  Column D                     Column E   Column F     Column G  Column H    Column I
  Paying Entity Name Paying Entity Recipient Name            Recipient FEIN               State or   Relationship Exception Amount Paid Addback 
                     FEIN                                                                 Country of Code         Code                  Amount
                                                                                          Domicile   (P, S, or B)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11. Total Column H

12. Total Column I. Carry this amount to lines 4 through 10 on Form IT-20 and use code 141

                                                             *24100000000*
                                                             24100000000

                  Instructions for Completing Schedule IT-20PIC

Complete all information requested. Report                Column G. Exception Code – Indiana statutes provide 
transactions with any member(s) of the same               for exceptions to adding back intangible expenses 
affiliated group (50% ownership threshold) or foreign     deducted for federal tax purposes. Enter the letter 
corporation(s) involving an intangible expense. Also      corresponding to the appropriate exception: 
report any directly related interest expense paid,        A) The taxpayer and all intangible income 
accrued, or incurred in transactions with one or more       recipients, for the purposes of the add-back 
members of the same affiliated group or one or more         requirement for line 6b of the return, are 
foreign corporations. Use Part 1 to report royalties,       included in the same consolidated or combined 
patent, copyright, or other intangible expenses. Use        Indiana return, or in an Indiana financial 
Part 2 to report interest expenses.                         institutions tax return. 
                                                           
Enclose a copy of federal Form 851 (Affiliation           B) The intangible expense corresponded to an 
Schedule) if filing a consolidated federal return.          item of income for a recipient that:
                                                            i)  was subject to financial institutions tax 
Part 1 - Related Transactions of Intangible Property                in Indiana;
                                                            ii)  filed an Indiana financial institutions 
Provide the following information on all related                    tax return in Indiana; and
transactions made with a recipient member of                iii) apportion the items of income that 
the same affiliated group or a foreign corporation                  corresponds to the expense as required 
involving an intangible expense.                                    under Indiana law.

Column A. Enter the name of the paying entity (This       C) The intangible expense corresponded to an 
should be the filing entity or a member of the filer’s      item of income for a recipient that:
consolidated or combined return)                            i)  was subject to a net income tax, 
                                                                    a franchise tax measured by net 
Column B. Enter the Federal Employer Identification                 income, or a value added tax in a 
Number (FEIN) of the paying entity                                  state or possession of the U.S or in a 
                                                                    country other than the U.S. that is its 
Column C. Enter the name of the recipient                           commercial domicile;
                                                            ii)  included the corresponding items of 
Column D. Enter the FEIN of the recipient. If the                   income within the recipient’s income 
recipient does not have an FEIN, leave blank                        that is subject to tax in that state or 
                                                                    possession of the U.S or in a country 
Column E. Enter the state or country of domicile of                 other than the U.S.;
the recipient                                               iii) resulted from transactions made at 
                                                                    a commercially reasonable rate that 
Column F. Enter letter corresponding to the                         is comparable to an arm’s length 
relationship of the recipient entity to the paying entity           transaction; and 
P) Parent                                                   iv)  resulted from transactions that did 
S) Subsidiary                                                       not have Indiana tax avoidance as a 
B) Brother/Sister                                                   principal purpose.

D) The items of income corresponding to the      H) The expense related to an amount paid to a 
  expense:                                         recipient that:
  i)  resulted from transactions with               i)  maintained a permanent office space 
  recipient’s on terms substantially similar                 with an adequate number of full-time 
  to transactions in which the recipient                     experienced employees to engage in 
  regularly engages in with one or more                      substantial business activities either 
  unrelated parties.                                         from acquisition, use, or disposition 
  ii)  resulted from transactions that did                   of intangible property, or from other 
  not have Indiana tax avoidance as a                        activities separate and apart from the 
  principal purpose.                                         intangible property; 
                                                    ii)  resulted from transactions made at 
E) The expense relates to an amount paid to the              a commercially reasonable rate that 
  recipient that:                                            is comparable to an arm’s length 
  i)  was made on the behalf of an unrelated                 transaction; and 
  party;                                            iii) resulted from transactions that did 
  ii)  was paid at an arm’s length rate; and                 not have Indiana tax avoidance as a 
  iii) resulted from transactions that did                   principal purpose 
  not have Indiana tax avoidance as a 
  principal purpose.                             I) An agreement is on file with the department 
                                                   allowing an alternative method of allocation or 
F) The expense related to an amount paid to the    apportionment under the adjusted gross income 
  recipient that:                                  tax statute; or
  i)  was for an amount that was received by 
  the taxpayer from an unrelated party           J) The department has determined, after the 
  and was paid to the recipient on behalf          taxpayer’s petition, that the adjustment is 
  of that unrelated party;                         unnecessary.
  ii)  resulted from transactions made at        
  a commercially reasonable rate that           Column H. Enter the amount paid, accrued, or 
  is comparable to an arm’s length              incurred (expensed). Round all entries to the nearest 
  transaction; and                              whole dollar.
  iii) resulted from transactions that did 
  not have Indiana tax avoidance as a           Column I. Enter the amount required to be added 
  principal purpose.                            back. This is the amount in Column H that does not 
G) The expense related to an amount paid to the meet an exception. Round all entries to the nearest 
  recipient that:                               whole dollar.
  i)  was equal to or greater than an amount 
  that the recipient paid, accrued, or          Report the total from Column I on Form IT-20, lines 
  incurred,  to an unrelated party in           4-10, as add-back code 140.
  connection with the same property 
  giving rise to the expense; and               Part 2- Transactions Involving Interest with a 
  ii)  resulted from transactions that did      Related Party
  not have Indiana tax avoidance as a 
  principal purpose.                            Provide the following information on all related 
                                                transactions made with a recipient member of 
                                                the same affiliated group or a foreign corporation 
                                                involving a directly related interest expenses. 

Column A. Enter the name of the paying entity (This        ii)  included the corresponding items of 
should be the filing entity or a member of the filer’s     income within the recipient’s income 
consolidated or combined return)                           that is subject to tax in that state or 
                                                           possession of the U.S or in a country 
Column B. Enter the Federal Employer Identification        other than the U.S.;
Number (FEIN) of the paying entity                         iii) resulted from transactions made at 
                                                           a commercially reasonable rate that 
Column C. Enter the name of the recipient                  is comparable to an arm’s length 
                                                           transaction; and 
Column D. Enter the FEIN of the recipient. If the          iv)  resulted from transactions that did 
recipient does not have an FEIN, leave blank               not have Indiana tax avoidance as a 
                                                           principal purpose.
Column E. Enter the state or country of domicile of 
the recipient                                            D) The items of income corresponding to the 
                                                           interest expense:
Column F. Enter the relationship of the recipient entity   i)  resulted from transactions with 
to the paying entity                                       recipient’s on terms substantially similar 
 P) Parent                                                 to transactions in which the recipient 
 S) Subsidiary                                             regularly engages in with one or more 
 B) Brother/Sister                                         unrelated parties.
                                                           ii)  resulted from transactions that did 
Column G. Exception Code – Indiana statutes provide        not have Indiana tax avoidance as a 
for exceptions to adding back intangible expenses          principal purpose. 
deducted for federal tax purposes. Enter the letter 
corresponding to the appropriate exception:              E) The interest expense relates to an amount paid 
 A) The taxpayer and all interest income recipients,       to the recipient that:
   for the purposes of the add-back requirement            i)  was made on the behalf of an unrelated 
   for line 6b of the return, are included in the          party;
   same consolidated or combined Indiana return,           ii)  was paid at an arm’s length rate; and
   or an Indiana financial institutions tax return.        iii) resulted from transactions that did 
                                                           not have Indiana tax avoidance as a 
 B) The interest expense corresponded to an item of        principal purpose.
   income for a recipient that:
   i)  was subject to financial institutions tax         F) The interest expense related to an amount paid 
              in Indiana;                                  to the recipient that:
   ii)  filed an Indiana financial institutions            i)  was for an amount that was received by 
              tax return in Indiana; and                   the taxpayer from an unrelated party 
   iii) apportioned the items of income                    and was paid to the recipient on behalf 
              that corresponded to the expense as          of that unrelated party;
              required under Indiana law.                  ii)  resulted from transactions made at 
                                                           a commercially reasonable rate that 
 C) The interest expense corresponded to an item of        is comparable to an arm’s length 
   income for a recipient that:                            transaction; and 
   i)  was subject to a net income tax,                    iii) resulted from transactions that did 
              a franchise tax measured by net              not have Indiana tax avoidance as a 
              income, or a value added tax in a            principal purpose.
              state or possession of the U.S or in a 
              country other than the U.S. that is its 
              commercial domicile

G) The interest expense related to an amount paid 
  to the recipient that:
   i)  was equal to or greater than an amount 
              that the recipient paid, accrued, or 
              incurred,  to an unrelated party in 
              connection with the same property 
              giving rise to the expense; and
   ii)  resulted from transactions that did 
              not have Indiana tax avoidance as a 
              principal purpose.

H) The interest expense related to an amount paid 
  to a recipient that:
   i)  maintained a permanent office space 
              with an adequate number of full-time 
              experienced employees to engage in 
              substantial business activities either 
              from acquisition, use, or disposition 
              of intangible property, or from other 
              activities separate and apart from the 
              intangible property; 
   ii)  resulted from transactions made at 
              a commercially reasonable rate that 
              is comparable to an arm’s length 
              transaction; and 
   iii) resulted from transactions that did 
              not have Indiana tax avoidance as a 
              principal purpose 

I) An agreement is on file with the department 
  allowing an alternative method of allocation or 
  apportionment under the adjusted gross income 
  tax statute; or

J) The department has determined, after the 
  taxpayer’s petition, that the adjustment is 
  unnecessary.

Column H. Enter the amount paid, accrued, or 
incurred (expensed). Round all entries to the nearest 
whole dollar. 

Column I. Enter the amount required to be added 
back. This is the amount in Column H that does not 
meet an exception. Round all entries to the nearest 
whole dollar. 

Report the total from Column I on Form IT-20, lines 
4-10, as add-back code 141.