IT-20S/IT-65 Indiana Department of Revenue
2022 Schedule IN K-1
State Form 49181 Shareholder’s/Partner’s Share of Indiana Adjusted Gross 
(R22 / 8-22)
Income, Deductions, Modifications, and Credits

 Tax Year Beginning 2022 and Ending

Name of S Corporation/Partnership Federal Employer Identification Number

Distributions - Provide Schedule IN K-1 to each shareholder/partner. Enclose Schedule IN K-1 with Form IT-20S/IT-65 return. 

Part 1 – Shareholder/Partner’s Identification Section
1. Shareholder/Partner Name

Check if amended
 le electronically le electronically2. Shareholder/Partner FEIN or Social Security Number 3. Shareholder/Partner Federal Pro Rata Percentage
fifi
%
.
4. If the partner is a disregarded entity (DE), enter the partner’s:
a. Name b. FEIN

5. What type of entity is the partner?

6. Shareholder/Partner State of Residence or Commercial Domicile 7. Indiana County of Principal Employment 2-digit code

8. Payer’s Name

9. Payer’s FEIN

10.   Amount of Distribution __________________________________________________________   10 .00

11. IN State Tax Withheld  ___________________________________________________________   11 .00 

12. Indiana Adjusted Gross Income subject to county tax ___________________________________     1 2  .00

13. IN County Tax Withheld  _________________________________________________________   13 .00
Part 2 - Pro Rata Share of Indiana Pass-through Tax Credits from S Corporation/Partnership
Column A Column B Column C Column D
IT-20S/IT65 Certification Certification/Project/PIN Tax Credit Column E
FEIN if Credit is from IN K-1 Year Number Code Amount Claimed

1. .00

2. .00

3. .00
Pass-through entities with more than 24 IN K-1s must Pass-through entities with more than 24 IN K-1s must 
4.  .00

*24100000000*
24100000000

Part 3 - Distributive Share Amount (use apportioned figures for nonresident shareholders/partners)
 1.  Ordinary business income (loss)  _________________________________________________               1           .00

 2.  Net rental real estate income (loss) _______________________________________________             2           .00

 3.  Other net rental income (loss)  ___________________________________________________              3           .00

 4.  Guaranteed payments (for IT-65 filers only; if filing IT-20S, skip to line 5)   ______________   4           .00

 5.  Interest income _______________________________________________________________                  5           .00

 6. Ordinary dividends ____________________________________________________________                   6           .00

 7. Royalties ____________________________________________________________________                    7           .00

 8.  Net short-term capital gain (loss) _________________________________________________             8           .00

 9.  Net long-term capital gain (loss)  _________________________________________________             9           .00

10.  Net IRC Section 1231 gain (loss) _________________________________________________               10          .00

11.  Other income (loss)  ___________________________________________________________                 11          .00

12.  IRC Section 179 expense deduction  ______________________________________________                12          .00

13.  a. Portion of expenses related to investment portfolio income, including investment interest 
     expense and other (federal nonitemized) deductions ________________________________   13a                    .00

    b. Other information from line 20 of federal K-1 related to investment interest and expenses not 
     listed elsewhere ____________________________________________________________                     13b        .00
14.  Total pro rata distributions (add lines 1 through 11; subtract lines 12, 13a, and 13b  
    when applicable) ______________________________________________________________                   14          .00

Part 4 - State Modifications  Add or subtract the following. Designate the distributive share amount of each modification for Indiana 
adjusted gross income from line 2 on the front of Form IT-20S/IT-65. 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.  Addback/Deduction _________________________________________               Code No.                5           .00

6.  Addback/Deduction _________________________________________               Code No.                6           .00

7.  Addback/Deduction _________________________________________               Code No.                7           .00

8.  Total distributive share of modifications (add lines 1 through 7)__________________________         8         .00

9.  Add Part 3, line 14, to Part 4, line 8. Nonresident partners/shareholders 
    should carry amount to Schedule Composite, Column C, or on  
    Schedule Composite-COR, Column B _______________________       Adjusted Gross Income           9                .00
                                                                 
                                            *24100000000*
                                                        24100000000