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04    Schedule F /                            Indiana Department of Revenue                                          Enclosure 
05    Schedule IN-DONATE                      Schedule F: Credits                                         Sequence No. 05
06    Form IT-40PNR                                                                           2024
      State Form 54033 
07    (R15 / 9-24)
08 Name(s) shown on Form IT-40PNR                                                         Your Social Security Number
09
10 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                        999          99 9999
11
12                                                                                                        Round all entries
13
14 1.  Indiana state tax withheld: See instructions ___________________________________________        1  99999999999.00
15
16 2.  Indiana county tax withheld: See instructions  _________________________________________        2  99999999999.00
17
18 3.  Pass Through Entity Tax Credit  ____________________________________________________             3 99999999999.00
19
20 4.  Estimated tax paid for 2024: include any extension payment made with Form IT-9  ____________    4  99999999999.00
21
22 5. Unified tax credit for the elderly ____________________________________________________          5  99999999999.00
23 6.  Earned income credit: see instructions
24    Enter earned income credit from 
25    Schedule IN-EIC, line A-3 _______________________________Box A      99999999999.00
26
27    Enter number from Schedule A, Proration Section, line 21D ___ Box B 9.99
28
29    Multiply Box A by Box B, enter total here _____________________________________________          6  99999999999.00
30
31 7.  Lake County residential income tax credit ____________________________________________          7  99999999999.00
32
33 8.  Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,  
34    line 19 (enclose schedule) ________________________________________________________              8  99999999999.00
35
36 9.  Economic development for a growing economy retention credit. Enter amount from  
37    Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________            9  99999999999.00
38
39 10.  Headquarters relocation credit (refundable portion - see instructions) _______________________ 10 99999999999.00
40
41 11.  Adoption Credit _________________________________________________________________              11 99999999999.00
42
43 12.  Reserved for future use __________________________________________________________             12                  .00
44
45 13.  Add lines 1 through 12. Enter total here and on Form IT-40PNR, line 12 _________ Total Credits 13 99999999999.00
46
47
48
49                                            Schedule IN-DONATE
50                     Important: The amount on line 2 cannot exceed the amount on Form IT-40PNR, line 16.
51
52 1.  Donations: List fund name, 3-digit code and amount to be donated (see instructions)
53
54    a.  Enter fund name XXXXXXXXXXXXXXXXXXXXXXXXXX                      code no.        999          1a 99999999999.00
55
56    b.  Enter fund name XXXXXXXXXXXXXXXXXXXXXXXXXX                      code no.        999          1b 99999999999.00
57
58    c.  Enter fund name XXXXXXXXXXXXXXXXXXXXXXXXXX                      code no.        999          1c 99999999999.00
59
60 2.  Add lines 1a through 1c. Enter total here and on Form IT-40PNR, line 17  _____ Total Donations   2 99999999999.00
61
62                                           *23824111694*
63                                                          23824111694
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