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04 Form IT-65                                                 Indiana Department of Revenue
   State Form 11800 
05 (R21 / 8-22)                                        Indiana Partnership Return                                                           2022
06                                               for Calendar Year Ending December  31, 2022
07                                                                                AA                                                        BB
08                    or  Other Tax Year Beginning              99         99        2022 and Ending        99     99             9999
09
10 Check box if amended.                    X A1 Check box if amendment is due to a federal audit.        X  B1           Check box if name changed.  X    C1
11 Name of Partnership                                                                                    B Federal Employer Identification Number    A
12
13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                            9999999999
14 Number and Street                                          C   Principal Business Activity CodeDForeign Country 2-Character Code
15                                                                                                                                         E
16   XXXXXXXXXXXXXXXXXXXXXXXXXXX                                               99999999                                          XX
17 City                                                         F          State     G     ZIP Code           H       2-Digit County Code
18                                                                                                                                         I
19         XXXXXXXXXXXXXXXXXXXX                                                XX          999999999                             XX          M. Year of initial 
20 Telephone Number          J       K. Date of organization               1      In the State of      2  L. State of commercial domicile    Indiana return
21
22       9999999999                  99                99       9999                 XX                            XX                             9999
23                                1                        2                3
24 N. Accounting method: Cash           X Accrual X             Other           X U. Check box if claiming a credit on Form IT-20RECX
25                                                                       1                 2                        3                             4
26  O. Check all boxes that apply to entity:   Initial Return           X   Final Return            X  In Bankruptcy       X     Composite ReturnX
27                                                     1                                                                         2
28  P. Enter total number of partners:         9999                      Enter number of nonresident partners: 9999
29
30  Q. I have on file a valid extension of time to file my return (federal Form 7004  or an electronic extension of time).           X       
31
32  R. This is a partnership that has elected to be subject to tax at the partnership level.           X      
33
34  S. This partnership is a member of another partnership(s).           X             T. This entity reports income from disregarded entities.   X
35
36  Aggregate Partnership Distributive Share Income (see worksheet)                                                                 Round all entries
37
38   1.  Total net income (loss) from U.S. partnership return, Form 1065 Schedule K (see instructions);  
39      use minus sign for negative amounts ______________________________________________                                         1 99999999999      .00
40
41   2.  a. Enter name of addback or deduction (see instructions)              XXXXXXXX        Code. No.     999                 2a  99999999999.00 
42
43      b. Enter name of addback or deduction          XXXXXXXXXXXXXXXXXX                      Code. No.     999                 2b  99999999999.00 
44
45      c. Enter name of addback or deduction          XXXXXXXXXXXXXXXXXX                      Code. No.     999                 2c  99999999999      .00 
46      d. Enter the total amount of addbacks and deductions from any additional sheets (use a 
47         minus sign for negative amount) ________________________________________________                                      2d  99999999999 .00
48
49   3.  Total partnership income, as adjusted (add lines 1 through 2d) __________________________                                 3 99999999999      .00
50   4.  Enter percentage for Indiana apportioned adjusted gross income from IT-65 Schedule E line 9,  
51      if applicable __________________________________________________________________                                           4 999. 99          %
52 Summary of Calculations
53   5.  Sales/use tax due on purchases subject to use tax from Sales/Use Tax worksheet  __________                                5 99999999999 .00
54   6.  a. Enter amount from line 15G of completed 
55         Schedule Composite  ____________________________                          6a  99999999999 .00
56      b. Enter amount from line 29C of completed 
57         Schedule Composite-COR ________________________                           6b  99999999999 .00
58         c. Enter amount from line 16 of completed
59         Schedule IN-EL  ________________________________       6c                                    99999999999.00
60      d. Add amounts from lines 6a - 6c. Attach Schedule Composite/Composite-COR/IN-EL                                         6d  99999999999.00
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04
05
06
07 7.  Total tax (add lines 5 and 6d). Caution:  If line 7 is zero, see line 16 late file penalty __________ 7      99999999999.00
08
09 8.  Total amount of pass-through withholding (enclose IN K-1 from the paying entity) ___________          8      99999999999.00
10
11 9.  Total composite withholding IT-6WTH payments (see instructions) _______________________               9      99999999999.00
12
13 10.  Other payments/credits (enclose documentation)  ____________________________________   10                   99999999999.00
14
15 11.  EDGE credit. Enter the total EDGE credit amount claimed (line 19 on Schedule IN-EDGE) ____   11             99999999999.00
16
17 12.  EDGE-R credit. Enter the total EDGE-R credit amount claimed (line 19 on Schedule IN-EDGE-R)  12             99999999999.00
18 13.  Certified Credits. Enter the total of certified credits claimed from Schedule IN-OCC and enclose  
19     this schedule with your return. ___________________________________________________   13                     99999999999.00
20
21 14. Subtotal (line 7 minus lines 8-13). If total is greater than zero, proceed to lines 15-17 ________    14     99999999999.00
22
23 15.  Interest: Enter total interest due; see instructions (contact the department for current interest rate)  15 99999999999.00
24 16. Penalty: If paying late, enter 10% of line 14. If line 7 is zero, enter $10 per day filed past the  
25     due date; see instructions _______________________________________________________   16                      99999999999.00
26 17.  Penalty: If failing to include all nonresident partners on composite return, enter $500;  
27     see instructions _______________________________________________________________                        17   99999999999.00
28 18. Total Amount Due (add lines 14-17). If less than zero, enter on line 19.  
29     Make payment in U.S. funds _____________________________________________________   18                        99999999999.00
30 19. Overpayment and Refund Amount (add lines 8-13, and then subtract lines 7, 15, 16, and 17).
31     No carryforward allowed.  _______________________________________________________   19                       99999999999.00
32 Certification of Signatures and Authorization Section
33 Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to the best 
34 of my knowledge and belief it is true, correct, and complete.                                                               EE
35
36 Signature                                                        Paid Preparer’s              XXXXXXXXXXXXXXXXXXXXXX
                                                                    Email Address 
37
38    I authorize the Department to discuss my return with my       Paid Preparer: Firm’s Name (or yours if self-employed) FF
39    personal representative (see instructions).
40           1          2                                        CC XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
41     Y X          N X    Date ____________________________        Paid Preparer’s Name                                   WW
42
43    Personal Representative’s Name (please print)              QQ XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
44                                                                                                                  NN
45    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                           PTIN         999999999
46    Email                                                      RR                                                        PP
47    Address                                                       Telephone Number                       9999999999
48           999999999999999999999999999999                                                                                    GG
49    Signature of                                                  Address XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
50    Corporate Officer __________________________________                                                                     HH
51                                                                  City         XXXXXXXXXXXXXXXXXXXXXXXXXXXXX
52    Print or Type Name of Corporate Officer                    LL         II                                      JJ
53                                                                  State           XX                     ZIP Code+4 999999999
54    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
55    Title                                                      MM Paid Preparer’s Signature ____________________________
56
57    XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                            Date _____________________________________________
58
59     If you owe tax, please mail your return to IN Department of  If you do not owe any tax, mail it to IN Department of Revenue, 
60       Revenue, PO Box 7205, Indianapolis, IN 46207-7205.                      PO Box 7147, Indianapolis, IN 46207-7147.
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