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04                                                                                                                                                                                                                     IT-20S/IT-65                                    Indiana Department of Revenue
                                                                                                                                                                                                                       2022 Schedule IN K-1
05                                                                                                                                                                                                                     State Form 49181         Shareholder’s/Partner’s Share of Indiana Adjusted Gross 
                                                                                                                                                                                                                       (R22 / 8-22)
06                                                                                                                                                                                                                                                  Income, Deductions, Modifications, and Credits
07                                                                                                                                                                                                                                                                                         AA                               BB
08                                                                                                                                                                                                                                                  Tax Year Beginning 99     99           2022 and Ending 99 99      9999
09
10                                                                                                                                                                                                                     Name of S Corporation/Partnership B                                                 Federal Employer Identification Number   A
11
12                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                          9999999999
13
14                                                                                                                                                                                                                     Distributions - Provide Schedule IN K-1 to each shareholder/partner. Enclose Schedule IN K-1 with Form IT-20S/IT-65 return. 
15
16                                                                                                                                                                                                                     Part 1 – Shareholder/Partner’s Identification Section
17                                                                                                                                                                                                                     1. Shareholder/Partner Name
18
19                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Check if amended                               X
20                                                                                                            le electronically le electronically                                                                      2. Shareholder/Partner FEIN or Social Security Number                  3. Shareholder/Partner Federal Pro Rata Percentage
21                                                                                                           fifi
                                                                                                                                                                                                                                                                                                                 %
22                                                                                                                                                                                                                         9999999999                                                               999. 99
23                                                                                                                                                                                                                     4. If the partner is a disregarded entity (DE), enter the partner’s:
24                                                                                                                                                                                                                       a. Name                                                                           b. FEIN
25
26                                                                                                                                                                                                                      XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                   9999999999
27                                                                                                                                                                                                                     5. What type of entity is the partner?
28
29                                                                                                                                                                                                                      XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
30                                                                                                                                                                                                                     6. Shareholder/Partner State of Residence or Commercial Domicile       7. Indiana County of Principal Employment 2-digit code
31
32                                                                                                                                                                                                                         XX                                                                       XX
33                                                                                                                                                                                                                     8. Payer’s Name
34
35                                                                                                                                                                                                                     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
36                                                                                                                                                                                                                     9. Payer’s FEIN
37
38                                                                                                                                                                                                                         9999999999
39                                                                                                                                                                                                                     10.   Amount of Distribution __________________________________________________________   10         99999999999.00
40
41                                                                                                                                                                                                                     11. IN State Tax Withheld  ___________________________________________________________   11          99999999999.00 
42
43                                                                                                                                                                                                                     12. Indiana Adjusted Gross Income subject to county tax ___________________________________     1 2  99999999999.00
44
45                                                                                                                                                                                                                     13. IN County Tax Withheld  _________________________________________________________   13           99999999999.00
46
47                                                                                                                                                                                                                     Part 2 - Pro Rata Share of Indiana Pass-through Tax Credits from S Corporation/Partnership
48                                                                                                                                                                                                                                      Column A             Column B                      Column C        Column D
49                                                                                                                                                                                                                                      IT-20S/IT65          Certification    Certification/Project/PIN    Tax Credit       Column E
50                                                                                                                                                                                                                         FEIN if Credit is from IN K-1     Year                          Number             Code          Amount Claimed
51
52                                                                                                                                                                                                                     1.          9999999999                9999             9999999999999999                9999          99999999999.00
53
54                                                                                                                                                                                                                     2.          9999999999                9999             9999999999999999                9999          99999999999.00
55
56                                                                                                                                                                                                                     3.          9999999999                9999             9999999999999999                9999          99999999999.00
57                                                                                                           Pass-through entities with more than 24 IN K-1s must Pass-through entities with more than 24 IN K-1s must 
58                                                                                                                                                                                                                     4.          9999999999                9999             9999999999999999                9999          99999999999.00
59
60
61
62                                                                                                                                                                                                                                                           *24100000000*
63                                                                                                                                                                                                                                                                            24100000000
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05
06 Part 3 - Distributive Share Amount (use apportioned figures for nonresident shareholders/partners)
07  1.  Ordinary business income (loss)  _________________________________________________               1    99999999999.00
08
09  2.  Net rental real estate income (loss) _______________________________________________             2    99999999999.00
10
11  3.  Other net rental income (loss)  ___________________________________________________              3    99999999999.00
12
13  4.  Guaranteed payments (for IT-65 filers only; if filing IT-20S, skip to line 5)   ______________   4    99999999999.00
14
15  5.  Interest income _______________________________________________________________                  5    99999999999.00
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17  6. Ordinary dividends ____________________________________________________________                   6    99999999999.00
18
19  7. Royalties ____________________________________________________________________                    7    99999999999.00
20
21  8.  Net short-term capital gain (loss) _________________________________________________             8    99999999999.00
22
23  9.  Net long-term capital gain (loss)  _________________________________________________             9    99999999999.00
24
25 10.  Net IRC Section 1231 gain (loss) _________________________________________________               10   99999999999.00
26
27 11.  Other income (loss)  ___________________________________________________________                 11   99999999999.00
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29 12.  IRC Section 179 expense deduction  ______________________________________________                12   99999999999.00
30
31 13.  a. Portion of expenses related to investment portfolio income, including investment interest 
32      expense and other (federal nonitemized) deductions ________________________________   13a             99999999999.00
33
34     b. Other information from line 20 of federal K-1 related to investment interest and expenses not 
35      listed elsewhere ____________________________________________________________                     13b 99999999999.00
36 14.  Total pro rata distributions (add lines 1 through 11; subtract lines 12, 13a, and 13b  
37     when applicable) ______________________________________________________________                   14   99999999999.00
38
39 Part 4 - State Modifications  Add or subtract the following. Designate the distributive share amount of each modification for Indiana 
40 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 
41 denote negative amounts.)
42 1.  State income taxes deducted ____________________________________________________                  1    99999999999.00
43
44 2.  Net bonus depreciation allowance  ________________________________________________                2    99999999999.00
45
46 3.  Excess IRC Section 179 deduction  _______________________________________________                 3    99999999999.00
47
48 4.  Interest on U.S. obligations ______________________________________________________               4    99999999999.00
49
50 5.  Addback/Deduction _________________________________________               Code No.      999       5    99999999999.00
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52 6.  Addback/Deduction _________________________________________               Code No.      999       6    99999999999.00
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54 7.  Addback/Deduction _________________________________________               Code No.      999       7    99999999999.00
55
56 8.  Total distributive share of modifications (add lines 1 through 7)__________________________         8      99999999999.00
57
58 9.  Add Part 3, line 14, to Part 4, line 8. Nonresident partners/shareholders 
59     should carry amount to Schedule Composite, Column C, or on  
       Schedule Composite-COR, Column B _______________________
60                                                                  Adjusted Gross Income           9         99999999999     .00
61
62                                             *24100000000*
63                                                         24100000000
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