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04 Schedule Composite                                           Indiana Department of Revenue
   State Form 49188
05 (R21 / 8-22)                                                 Entity’s Composite Indiana 
06                                                       Adjusted Gross Income Tax Return
07
                               AA                                          BB
08
   Entity’s Tax Year 2022 or Other Year Beginning        2022 and Ending
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10
11 Name of Entity B                                                                                                                            Federal Employer Identification Number A
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14 See instructions. Enclose with Form IT-20S, IT-65, or IT-41. Use additional sheets if necessary.
15                                                Exception                State of        Enter Pro Rata                               Composite Adjusted Gross and 
16                                                Code                     residency               Share                                       County Income Tax                                                     Total Tax
17                                                       A                 B                       C                              D                   E                                                     F        G
18                                                Enter                    Enter the       Adjusted gross                   State Tax.         Income              County tax.                                       Enter partner/
                                                  exception code           2-character     income attributed                Multiply C by      subject to county   Multiply E by                                     shareholder/
19                                                (see                     state of        to Indiana from                  .0323 (leave       tax from IN K-1,    county tax rate                                   beneficiary tax 
20                                                instructions)            residency       IT-20S/IT-65 IN                  blank if less than Part 1, line 12, or (leave blank if                                   liability (D + F)
                                                                           for each non-   K-1, Part 4, Line                zero)              IT-41 IN K-1, Part  less than zero)
21 Individual / Non-Corporate                                              resident listed 9, or IT-41 IN K-1,                                 1, line 13
22 Entity Name                                                                             Part 4, line 9
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42 13. Subtotal Column D and Column F; add together and enter total in Column G ...................................
43 14. Carryover totals from Columns D, F, and G from additional sheets ....................................................
44
   15. Total tax (13G + 14G). Enter this amount on line 15 of Form IT-20S; 
45     line 6a of Form IT-65; or, on Form IT-41, Schedule 1, line 2.........................................................................................................................................Total Tax
46
47                                                       *24100000000*
48                                                                                   24100000000
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