Schedule 7                                      Indiana Department of Revenue                                             Enclosure      
                                                                                                         Sequence No. 06
      Form IT-40               Schedule 7: Additional Required Information                       2024
      State Form 54000 
      (R15 / 9-24)
Name(s) shown on Form IT-40                                                            Your Social Security Number

1. Federal filing information
Are you filing a federal income tax return for 2024? Place “X” in appropriate box. Yes         No
2.  Out-of-state income
Complete if you and/or your spouse (if filing a joint return) received any salary, wage, tip and/or commission income from Illinois, 
Kentucky, Michigan, Ohio, Pennsylvania or Wisconsin. Enter two-digit code number from the back of Schedule CT-40 for state where 
you and/or your spouse worked.
State where you worked         Your income                    State where spouse worked                  Spouse’s income

                                                      .00                                                                       .00
3. Extension of time to file
   a.  Place “X” in box if you have filed a federal extension of time to file, Form 4868, or made an online extension payment.  

   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.

4. Farm/Fishing income
Place “X” in box if at least two-thirds of your gross income was made from farming or fishing.
Important: If you placed an “X” in the box, you MUST attach Schedule IT-2210.
5. Schedule IN-40PA filers
If you are eligible to file federal Form 8857, Request for Innocent Spouse Relief, and are completing Indiana Schedule IN-40PA, 
enclose Schedule IN-40PA and check the box.
6.  Date of death
If any individual listed at the top of the IT-40 died during 2024, enter date of death (MM/DD).

      Taxpayer’s date of death                        2024  Spouse’s date of death               2024
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, 
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 
all taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of 
Revenue (DOR) to furnish my financial institution with my routing number, account number, account type and Social Security number 
to ensure my refund is properly deposited. I grant permission to DOR to contact the Social Security Administration to confirm that the 
Social Security number(s) used on this return is correct.

7.  Your daytime                                            Your email 
   telephone number                                         address

I authorize the Department to discuss my return with my       Paid Preparer: Firm’s Name (or yours if self-employed)
personal representative.
Yes       No           If yes, complete the information below.

Personal Representative’s Name (please print)                          IN-OPT on file with paid preparer if not filing electronically

                                                              PTIN
Telephone 
number                                                        Address

Address                                                       City

City                                                          State                              ZIP Code
                                                              Preparer’s 
State                        ZIP Code                         signature

                                      *23324111694*
                                                            23324111694