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

Name(s) shown on IT-40PNR                                                       Your Social Security Number

Section 1 – Income or (Loss)
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 
1040 Schedule 1 (except for line 19B and/or a net operating loss carryforward on line 20B; see instructions). Round all entries.
                                                                     Column A                       Column B 
                                                              Income from Federal Return        Income Taxed by Indiana 

1.  Your wages, salaries, tips, commissions, etc ____________   1A              .00             1B                              .00

2.  Spouse’s wages, salaries, tips, commissions, etc  ________   2A             .00             2B                              .00

3.  Taxable interest income  ____________________________   3A                  .00             3B                              .00

4.  Dividend income __________________________________   4A                     .00             4B                              .00
5.  Taxable refunds, credits, or offsets of state 
    and local taxes from your federal return ________________   5A              .00             5B                              .00

6.  Alimony received__________________________________   6A                     .00             6B                              .00

7.  Business income or loss from federal Schedule C ________   7A               .00             7B                              .00
8.  Capital gain or loss from sale or exchange 
    of property from your federal return  ___________________   8A              .00             8B                              .00

9.  Other gains or (losses) from Form 4797 ________________   9A                .00             9B                              .00

10.  Taxable IRA distribution  ____________________________   10A               .00             10B                             .00

11.  Taxable pensions and annuities ______________________   11A                .00             11B                             .00
12.  Net rent or royalty income or loss reported on 
    federal Schedule E ________________________________   12A                   .00             12B                             .00

13.  Income or loss from partnerships _____________________   13A               .00             13B                             .00

14.  Income or loss from trusts and estates _________________   14A             .00             14B                             .00

15.  Income or loss from S corporations  ___________________   15A              .00             15B                             .00

16.  Farm income or loss from federal Schedule F ___________   16A              .00             16B                             .00

17.  Unemployment compensation  _______________________   17A                   .00             17B                             .00

18. Taxable Social Security benefits ______________________   18A               .00             18B                             .00
19.  Indiana apportioned income from 
    Schedule IT-40PNRA ___________________________________________________________   19B                                        .00

20.  Other income reported on your federal return ____________   20A            .00             20B                             .00 
    List source(s). (Do not include federal net operating loss in Column B. See instructions.)  

21.  Subtotal: add lines 1 through 20 ______________________  21A               .00             21B                             .00

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     Schedule A                                   Indiana Department of Revenue                                       Enclosure 
     Form IT-40PNR                                Schedule A, Proration                                      Sequence No. 01A
     (continued)                                                                               2024           Page 2 of 2
                                     Section 2: Adjustments to Income

Proration Section – See instructions.

21C. Note: Nonresident military personnel see special instructions and complete worksheet ________   21C                        .00

21D. For all other individuals, divide the amount on line 21B by the amount on line 21A (see instructions  
     if either line 21A and/or 21B are less than zero). Please round your answer to a decimal followed  
     by three numbers. Example: $3,100 ÷ $8,000 = .3875, which rounds to .388 (do not enter a  
     number greater than 1.00). Enter result here and on Schedule D, line 8 ____________________   21D       .

Section 2 – Adjustments to Income
Note: Enter in Column A only those deductions claimed on your 2024 federal income tax return, Form 1040, Form 1040-SR, and  
Form 1040, Schedule 1, Part II. Round all entries.
                                                                       Column A                              Column B 
                                                                       Federal Adjustments                   Indiana Adjustments

22.  Educator expenses (see instructions) __________________   22A              .00                     22B                     .00
23.  Certain business expenses of reservists, 
     performing artists, etc ______________________________   23A               .00                     23B                     .00

24.  Health savings account deduction  ____________________   24A               .00                     24B                     .00

25.  Moving expenses (see instructions) ___________________   25A               .00                     25B                     .00

26.  Deductible part of self-employment tax _________________   26A             .00                     26B                     .00

27.  Self-employed, SEP, SIMPLE, and qualified plans ________   27A             .00                     27B                     .00

28.  Self-employed health insurance deduction ______________   28A              .00                     28B                     .00

29.  Penalty on early withdrawal of savings _________________   29A             .00                     29B                     .00

30.  Alimony paid _____________________________________   30A                   .00                     30B                     .00

31.  IRA deduction ____________________________________   31A                   .00                     31B                     .00

32.  Student loan interest deduction (see instructions) ________   32A          .00                     32B                     .00

33.  Reserved for future use  ____________________________   33A                .00                     33B                     .00

34.  Other (see instructions)                             34A                   .00                     34B                     .00

35.  Add lines 22 through 34 ____________________________      35A              .00                     35B                     .00

Section 3 – Totals

36.  Subtract line 35 from line 21 of Section 1. Carry  
     amount from line 36B to Form IT-40PNR, line 1  _________  36A              .00                     36B                     .00

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                                                        23424121694






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