SCHEDULE E                                      Indiana Department of Revenue
Form IT-20/20S/20NP/IT-65
State Form 49105                     Apportionment of Income for Indiana
(R21 / 8-22)
                         for Tax Year Beginning             2022 and Ending

Name as shown on return                                                           Federal Employer Identification Number

Each filing entity having income from sources both within and outside Indiana must complete an apportionment schedule except financial institutions 
and certain insurance companies that use a single receipts factor.  Interstate transportation entities must use Schedule E-7. Combined unitary filers 
must use the apportioning method (relative formula percentage) as outlined in Information Bulletin #12 and Tax Policy Directive #6. Omit cents;  
percents should be rounded two decimal places; read apportionment instructions.

Part I - Indiana Apportionment of Adjusted Gross Income
Sales/Receipts (less returns and allowances) 
Include all non-exempt apportioned gross business income. Do not use non-unitary partnership income of previously apportioned 
income that must be separately reported as allocated income.

                                                Column A                          Column B              Column C
                                          Total Within Indiana                    Total Within and      Indiana 
                                                                                  Outside Indiana       Percentage
Sales delivered or shipped  
to Indiana:
 1. Shipped from within  
    Indiana                                                 .00

 2. Shipped from outside  
    Indiana                                                 .00

Sales shipped from Indiana to:
 3. The United States  
    government                                              .00
 4.  Purchasers in a state where  
    the taxpayer is not subject to  
    income tax (under P.L. 86-272) 
    (for years beginning prior to                           .00 
    Jan. 1, 2016 only)
Other
 5.  Interest & other receipts from  
    extending credit attributed to  
    Indiana                                                 .00
 6.  Other gross business receipts  
    not previously apportioned                              .00
 7.  Direct premiums and annuities  
    received for insurance upon  
    property or risks in Indiana                            .00
 8.  Total Receipts: Add column A  
    receipts lines on 1A through  
    7A and enter in line 8A. Enter  
    all receipts on line 8B          8A                     .00                8B                  .00

Apportionment of income for  
Indiana:
 9.  Apportionment Percentage:  
    Divide line 8A by line 8B (insert as  
    percent, not decimal)                                                                             9 .                     %

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Schedule E                                                                                                            Page 2
Part II - Business/Other Income Questionnaire
1.  List all business locations where the taxpayer has operations or partnership interests and indicate type of activities. This section 
must be completed - attach additional sheets if necessary.

City                                                       State     Nature of Business Activity

Accepts                               Registered to                  Files Returns 
Orders?       Yes     No              Do Business?         Yes   No  in State?                                Yes     No
Property in                                    Property in 
State Leased?     Yes    No                    State Owned?      Yes No

City                                                       State     Nature of Business Activity

Accepts                               Registered to                  Files Returns 
Orders?       Yes     No              Do Business?         Yes   No  in State?                                Yes     No
Property in                                    Property in 
State Leased?     Yes    No                    State Owned?      Yes No

City                                                       State     Nature of Business Activity

Accepts                               Registered to                  Files Returns 
Orders?       Yes     No              Do Business?         Yes   No  in State?                                Yes     No
Property in                                    Property in 
State Leased?     Yes    No                    State Owned?      Yes No

City                                                       State     Nature of Business Activity

Accepts                               Registered to                  Files Returns 
Orders?       Yes     No              Do Business?         Yes   No  in State?                                Yes     No
Property in                                    Property in 
State Leased?     Yes    No                    State Owned?      Yes No

2.  Briefly describe the nature of Indiana business activities, including the exact title and principal business activity of any partnership 
in which the taxpayer has an interest:

3.  Indicate any partnership in which you have a unitary or general partnership relationship:

4.  Briefly describe the nature of activities of sales personnel operating and soliciting business in Indiana:

5.  Do Indiana receipts for line 3A include all sales shipped from Indiana to (1) the U.S. government;  
or (2) locations where this taxpayer’s only activity in the state of the purchaser consists of the mere  
solicitation of orders? If no, please explain.                                                                    Yes   No

6.  List the source of any directly allocated income from partnerships, estates, and trusts not in the taxpayer’s apportioned tax base:

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