Schedule                 Indiana Withholding and Composite 
         IN-COMPA                Filing Opt-Out Affidavit
        State Form 52826
        (R2 / 5-22)

 Pass-Through Entity Information
 Name of Entity                                                 FEIN

 Address

 City, State, ZIP Code

Type of Pass-Through Entity: 

       Partnership               S Corporation    Estate         Trust  
 □                           □                 □               □
 Nonresident Information
 Name                                                           FEIN/SSN

 Address

 City, State, ZIP Code

 Type of Entity

 Year(s) (see instructions)

Please check the reason(s) for claiming an exemption for, or reduction in the amount of withholding:

  The entity is an employee stock ownership plan. (03)
□
  The entity is an insurance company not subject to adjusted gross income tax or financial institutions tax. (05)
□
  The entity is a nonprofit (including IRAs and other retirement plans) and the income is unrelated business  
□
  income to the entity. (06)

  The entity is a real estate investment trust. Do not claim this exemption if the entity is a captive real estate 
□
  investment trust. (07)

  The entity is a real estate mortgage investment conduit. (08)
□
  The entity is permitted a treaty-based exemption from income tax. Please list the country and the relevant 
□
  provision of the treaty (if known). (09) ____________________________

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  The income is subject to reduction because the entity claiming ownership has an allowable loss to be  
□
   applied against the income.
  
   Suspended losses (list amount allowable) (04)                ________________ 
 □
 
        Claimed                                                 ________________ 
                                                                     
   Passive activity losses (list amount allowable) (10)         ________________
 □
        Claimed                                                 ________________   
  
   Indiana net operating losses (list amount allowable) (11)     ________________ 
 □
        Claimed                                                 ________________   
 
□ The tax owed by the entity is reduced by either Indiana credit carryforwards or Indiana credits from other  
 sources. List the credit, amount, the year in which the credit was earned, and the FEIN or Social Security  
 number of the source. (12)

   Credit                                      Year          FID of 
                 Amount
  (3-digit code)                               Earned        Source

□ The entity is a corporation or financial institution that is registered with the Indiana Secretary of State to  
 do business in Indiana and is remitting estimated payments on the income from the pass-through entity.  
 List the FID if the corporation otherwise subject to withholding is different than the corporation reporting  
 the tax for Indiana purposes. (13) _________________________

Under penalties of perjury, I understand that I am responsible for filing any Indiana tax returns and remitting 
any tax due as a result of the pass-through entity’s income derived from Indiana sources. I further agree 
that I consent to the jurisdiction of the state of Indiana with regard to any income, return filing, assessment, 
and rights of appeal. I further agree that this waiver of withholding does not apply if a partnership is subject 
to adjustments resulting from Indiana or federal adjustments, including audits, administrative adjustment 
requests, and amended returns. This agreement may be revoked at any time by the Indiana Department of 
State Revenue (“Department”), and the Department may notify the pass-through entity listed above of the 
revocation and any disallowance of waivers. 
 
Name: _________________________________        Name (printed): _________________________
 
Title (if applicable): _______________________ Date: ________________________________

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                                    Instructions for Indiana Withholding and 
                                    Composite Filing Opt-Out Affidavit

The Schedule IN-COMPA is intended as a schedule to permit               For the year, enter the first year and last year of the election 
a shareholder, partner, or beneficiary to have nonresident tax          (for instance, 2022-2026 or 2022-forward) only for the first five 
withholding reduced or eliminated in certain cases. These               reasons listed in the affidavit or for the reason associated with 
cases are intended to be those circumstances where an ultimate          corporations registered in Indiana and remitting estimated 
taxpayer would have an Indiana income tax liability that is             payments. For all other listed reasons, enter only the current 
significantly lower than the amount required to be withheld or          taxable year. 
withholding would result in duplicate collection of the same tax.        
                                                                        If multiple tax years are entered appropriately, the affidavit 
A pass-through entity is not required to accept the affidavit. If a     generally is required to be completed only once for the entire 
pass-through entity does not accept this affidavit, withholding         period specified unless the department specifically voids the 
is required in the same manner as if no affidavit had been              affidavit. However, if there is a material change in law (as 
completed. In addition, the department may void any affidavit and  published in the Indiana Register) or material change in fact, the 
may require a pass-through entity to not accept an affidavit upon       listing of multiple years is void upon such material change. 
notification by the department. 
                                                                        Reasons for Claiming Exemption or Reduction in 
For a pass-through entity, any completed affidavits are required to     Withholding 
be attached to the pass-through entity’s return each year for which 
the affidavit applies. Failure to attach an affidavit shall be treated  Please check at least one box specifying a reason for reduced or 
as if the affidavit had not been completed for that taxable year        eliminated withholding. More than one box can be checked. 
and composite tax will be assessed. 
                                                                        Each box has a number in parentheses after the explanation. The 
For a partner, shareholder, or beneficiary, the affidavit may be        pass-through entity is required to list the code in Column A on 
attached to the return. However, attachment is not required. The        the line of Schedule Composite or Schedule Composite-COR 
partner, shareholder, or beneficiary must provide a completed           associated with the nonresident completing this affidavit. If more 
copy of the affidavit upon department request.                          than one box is checked, the pass-through entity is required 
                                                                        to list one of the allowable codes in Column A of the Schedule 
The affidavit must be completed by the nonresident before the 15th      Composite or Schedule Composite-COR. 
day of the fourth month following the end of the pass-through            
entity’s tax year. In the case of an affidavit covering multiple years, If you are claiming an exemption because of an allowable loss, 
failure to complete the affidavit in a timely manner will result in     you are required to specify each amount of loss that is potentially 
the affidavit being treated as void for that taxable year.              applicable against the income from the pass-through entity. 

IMPORTANT: In the event of an amended return by the                     If you are claiming that you have a credit that (1) is from another 
pass-through entity or a department adjustment to the pass-             entity or (2) is a carryforward from a previous year, regardless of 
through entity, this affidavit will not relieve the pass-through        whether the credit was generated by this pass-through entity, list 
entity of withholding based on the amended return. Further,             each credit separately. Use the three-digit code assigned to the 
this affidavit cannot be used to relieve a partnership of any           credit by the department. A list of available credits for a non-
tax otherwise due as a result of adjustments if the partnership         resident can be found in the relevant instruction booklet for the 
elects to be taxed at the partnership level.                            nonresident’s normal return filing.

Nonresident Information 

Enter all fields for the affected nonresident. For type of entity, 
use a common description (e.g., individual, S corporation, C 
corporation, etc.). 

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