Schedule 5 /                      Indiana Department of Revenue                                                Enclosure 
   Schedule IN-DONATE                Schedule 5: Credits                                                Sequence No. 04
   Form IT-40                                                                          2024
   State Form 53998 
   (R15 / 9-24)
Name(s) shown on Form IT-40                                                            Your Social Security Number

                                                                                                        Round all entries

1.  Indiana state tax withheld: See instructions ___________________________________________         1                   .00

2.  Indiana county tax withheld: See instructions  _________________________________________         2                   .00

3.  Pass Through Entity Tax Credit  ____________________________________________________             3                   .00

4.  Estimated tax paid for 2024: include any extension payment made with Form IT-9  ____________     4                   .00

5. Unified tax credit for the elderly ____________________________________________________           5                   .00

6.  Earned income credit: enclose Schedule IN-EIC and enter amount from line A-3  _____________      6                   .00

7.  Lake County residential income tax credit ____________________________________________           7                   .00

8.  Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,  
   line 19 (enclose schedule) ________________________________________________________               8                   .00

9.  Economic development for a growing economy retention credit. Enter amount from  
   Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________             9                   .00

10.  Headquarters relocation credit (refundable portion - see instructions) _______________________  10                  .00

11.  Adoption Credit _________________________________________________________________               11                  .00

12.  Reserved for future use __________________________________________________________              12                  .00

13.  Add lines 1 through 12. Enter total here and on Form IT-40, line 12 _____________ Total Credits 13                  .00

                                     Schedule IN-DONATE
                       Important: The amount on line 2 cannot exceed the amount on Form IT-40, line 16.

1.  Donations: List fund name, 3-digit code and amount to be donated (see instructions)

   a.  Enter fund name                                                       code no.                1a                  .00

   b.  Enter fund name                                                       code no.                1b                  .00

   c.  Enter fund name                                                       code no.                1c                  .00 

2.  Add lines 1a through 1c. Enter total here and on Form IT-40, line 17 _________ Total Donations   2                   .00

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