01
0000000000111111111122222222223333333333444444444455555555556666666666777777777788888
1234567890123456789012345678901234567890123456789012345678901234567890123456789012345
04       Schedule 7                                      Indiana Department of Revenue                                              Enclosure     
                                                                                                                Sequence No. 06
05       Form IT-40               Schedule 7: Additional Required Information                          2024
         State Form 54000 
06       (R15 / 9-24)
07 Name(s) shown on Form IT-40                                                            Your Social Security Number
08
09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                999    99     9999
10 1. Federal filing information
11 Are you filing a federal income tax return for 2024? Place “X” in appropriate box. Yes X       No  X
12
   2.  Out-of-state income
13 Complete if you and/or your spouse (if filing a joint return) received any salary, wage, tip and/or commission income from Illinois, 
14 Kentucky, Michigan, Ohio, Pennsylvania or Wisconsin. Enter two-digit code number from the back of Schedule CT-40 for state where 
15 you and/or your spouse worked.
16 State where you worked         Your income                     State where spouse worked                 Spouse’s income
17
18        XX                      999999999.00                                        XX                 999999999                  .00
19 3. Extension of time to file
20    a.  Place “X” in box if you have filed a federal extension of time to file, Form 4868, or made an online extension payment.  X
21
22    b.  Place “X” in box if you have filed an Indiana extension of time to file, Form IT-9, or made an Indiana extension payment online. X
23
24 4. Farm/Fishing income
25 Place “X” in box if at least two-thirds of your gross income was made from farming or fishing. X
26 Important: If you placed an “X” in the box, you MUST attach Schedule IT-2210.
27 5. Schedule IN-40PA filers
28 If you are eligible to file federal Form 8857, Request for Innocent Spouse Relief, and are completing Indiana Schedule IN-40PA,         X
29 enclose Schedule IN-40PA and check the box.
30 6.  Date of death
31 If any individual listed at the top of the IT-40 died during 2024, enter date of death (MM/DD).
32
33       Taxpayer’s date of death 99     99              2024  Spouse’s date of death     99          99 2024
34
35 Authorization – Sign Form IT-40 after reading the following statement.
   Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, 
36 complete and correct. I understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for 
37 all taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of 
38 Revenue (DOR) to furnish my financial institution with my routing number, account number, account type and Social Security number 
39 to ensure my refund is properly deposited. I grant permission to DOR to contact the Social Security Administration to confirm that the 
40 Social Security number(s) used on this return is correct.
41
42 7.  Your daytime                                            Your email 
43    telephone number     999999999999999                     address                   XXXXXXXXXXXXXXXXXXXXXX
44
45 I authorize the Department to discuss my return with my        Paid Preparer: Firm’s Name (or yours if self-employed)
   personal representative.
46
47 Yes  X    No X         If yes, complete the information below. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
48
49 Personal Representative’s Name (please print)                   X      IN-OPT on file with paid preparer if not filing electronically
50
51 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                            PTIN                    999999999
52 Telephone 
53 number            9999999999                                   Address XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
54
55 Address XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                         City                XXXXXXXXXXXXXXXXXXXXXX
56
57 City      XXXXXXXXXXXXXXXXXXXXXX                               State                  XX            ZIP Code 999999999
58                                                                Preparer’s 
59 State        XX              ZIP Code 999999999                signature
60
61
62                                       *23324111694*
63                                                             23324111694
64
65
66