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04     Schedule A                                    Indiana Department of Revenue                              Enclosure 
05     Form IT-40PNR                    Schedule A, Section 1: Income or Loss                           Sequence No. 01
       State Form 48719 
06     (R23 / 9-24)                     (Complete Proration, Section 2 and Section 3 on back.)     2024       Page 1 of 2

07 Name(s) shown on IT-40PNR                                                       Your Social Security Number
08
09 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                 999             99   9999
10 Section 1 – Income or (Loss)
11 Enter in column A the same income or loss you reported on your 2024 federal income tax return, Form 1040, Form 1040-SR, and Form 
12 1040 Schedule 1 (except for line 19B and/or a net operating loss carryforward on line 20B; see instructions). Round all entries.
13                                                                      Column A                       Column B 
14                                                               Income from Federal Return        Income Taxed by Indiana 
15
16 1.  Your wages, salaries, tips, commissions, etc ____________   1A   99999999999.00             1B  99999999999.00
17
18 2.  Spouse’s wages, salaries, tips, commissions, etc  ________   2A  99999999999.00             2B  99999999999.00
19
20 3.  Taxable interest income  ____________________________   3A       99999999999.00             3B  99999999999.00
21
22 4.  Dividend income __________________________________   4A          99999999999.00             4B  99999999999.00
23 5.  Taxable refunds, credits, or offsets of state 
24     and local taxes from your federal return ________________   5A   99999999999.00             5B  99999999999.00
25
26 6.  Alimony received__________________________________   6A          99999999999.00             6B  99999999999.00
27
28 7.  Business income or loss from federal Schedule C ________   7A    99999999999.00             7B  99999999999.00
29 8.  Capital gain or loss from sale or exchange 
30     of property from your federal return  ___________________   8A   99999999999.00             8B  99999999999.00
31
32 9.  Other gains or (losses) from Form 4797 ________________   9A     99999999999.00             9B  99999999999.00
33
34 10.  Taxable IRA distribution  ____________________________   10A    99999999999.00             10B 99999999999.00
35
36 11.  Taxable pensions and annuities ______________________   11A     99999999999.00             11B 99999999999.00
37 12.  Net rent or royalty income or loss reported on 
38     federal Schedule E ________________________________   12A        99999999999.00             12B 99999999999.00
39
40 13.  Income or loss from partnerships _____________________   13A    99999999999.00             13B 99999999999.00
41
42 14.  Income or loss from trusts and estates _________________   14A  99999999999.00             14B 99999999999.00
43
44 15.  Income or loss from S corporations  ___________________   15A   99999999999.00             15B 99999999999.00
45
46 16.  Farm income or loss from federal Schedule F ___________   16A   99999999999.00             16B 99999999999.00
47
48 17.  Unemployment compensation  _______________________   17A        99999999999.00             17B 99999999999.00
49
50 18. Taxable Social Security benefits ______________________   18A    99999999999.00             18B 99999999999.00
51 19.  Indiana apportioned income from 
52     Schedule IT-40PNRA ___________________________________________________________   19B            99999999999.00
53
54 20.  Other income reported on your federal return ____________   20A 99999999999.00             20B 99999999999.00 
55     List source(s). (Do not include federal net operating loss in Column B. See instructions.)  
56
57     XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
58
59 21.  Subtotal: add lines 1 through 20 ______________________  21A    99999999999.00             21B 99999999999.00
60
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62                                      *23424111694*
63                                                     23424111694
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04      Schedule A                                   Indiana Department of Revenue                                       Enclosure 
05      Form IT-40PNR                                Schedule A, Proration                                      Sequence No. 01A
        (continued)                                                                               2024           Page 2 of 2
06                                      Section 2: Adjustments to Income
07
08
09 Proration Section – See instructions.
10
11 21C. Note: Nonresident military personnel see special instructions and complete worksheet ________   21C     99999999999.00
12
13 21D. For all other individuals, divide the amount on line 21B by the amount on line 21A (see instructions  
14      if either line 21A and/or 21B are less than zero). Please round your answer to a decimal followed  
15      by three numbers. Example: $3,100 ÷ $8,000 = .3875, which rounds to .388 (do not enter a  
16      number greater than 1.00). Enter result here and on Schedule D, line 8 ____________________   21D       9.999
17
18 Section 2 – Adjustments to Income
19 Note: Enter in Column A only those deductions claimed on your 2024 federal income tax return, Form 1040, Form 1040-SR, and  
20 Form 1040, Schedule 1, Part II. Round all entries.
21                                                                        Column A                              Column B 
22                                                                        Federal Adjustments                   Indiana Adjustments
23
24 22.  Educator expenses (see instructions) __________________   22A     99999999999.00                   22B  99999999999.00
25 23.  Certain business expenses of reservists, 
26      performing artists, etc ______________________________   23A      99999999999.00                   23B  99999999999.00
27
28 24.  Health savings account deduction  ____________________   24A      99999999999.00                   24B  99999999999.00
29
30 25.  Moving expenses (see instructions) ___________________   25A      99999999999.00                   25B  99999999999.00
31
32 26.  Deductible part of self-employment tax _________________   26A    99999999999.00                   26B  99999999999.00
33
34 27.  Self-employed, SEP, SIMPLE, and qualified plans ________   27A    99999999999.00                   27B  99999999999.00
35
36 28.  Self-employed health insurance deduction ______________   28A     99999999999.00                   28B  99999999999.00
37
38 29.  Penalty on early withdrawal of savings _________________   29A    99999999999.00                   29B  99999999999.00
39
40 30.  Alimony paid _____________________________________   30A          99999999999.00                   30B  99999999999.00
41
42 31.  IRA deduction ____________________________________   31A          99999999999.00                   31B  99999999999.00
43
44 32.  Student loan interest deduction (see instructions) ________   32A 99999999999.00                   32B  99999999999.00
45
46 33.  Reserved for future use  ____________________________   33A       99999999999.00                   33B  99999999999.00
47
48 34.  Other (see instructions) XXXXXXXXXXXXXXXXXXX   34A                99999999999.00                   34B  99999999999.00
49
50 35.  Add lines 22 through 34 ____________________________      35A     99999999999.00                   35B  99999999999.00
51
52
53 Section 3 – Totals
54
55 36.  Subtract line 35 from line 21 of Section 1. Carry  
56      amount from line 36B to Form IT-40PNR, line 1  _________  36A     99999999999.00                   36B  99999999999.00
57
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62                                      *23424121694*
63                                                         23424121694
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