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Schedule IN-W Indiana Department of Revenue Enclosure
Form IT-40, IT-40PNR, IT-40RNR Indiana Withholding Statements Sequence No. 26
State Form 53056 (R2 / 9-24) 2024
Name(s) shown on Form IT-40/IT-40PNR/IT-40RNR Your Social Security Number
A B C D E F G H
Social Security Form Employer or State State Tax Local Local Tax Locality
Number Code Payer ID Number Income Withheld Income Withheld Code
1
00 00 00 00
2
00 00 00 00
3
00 00 00 00
4
00 00 00 00
5
00 00 00 00
6
00 00 00 00
7
00 00 00 00
8
00 00 00 00
9
00 00 00 00
10
00 00 00 00
11
00 00 00 00
12
00 00 00 00
13
00 00 00 00
14
00 00 00 00
15
00 00 00 00
16
00 00 00 00
17
00 00 00 00
18
00 00 00 00
19
00 00 00 00
20
00 00 00 00
21
00 00 00 00
22
00 00 00 00
23
00 00 00 00
24
00 00 00 00
25
00 00 00 00
Add lines 1 through 25 column E. Enter total on line 1 of
26 IT-40 Schedule 5, or line 1 of IT-40PNR Schedule F, or
line 7 of IT-40RNR. 00
Add lines 1 through 25 column G. Enter total on line 2 of IT-40 Schedule 5, or
27
line 2 of IT-40PNR Schedule F, or line 8 of IT-40RNR.
00
Schedule IN-W Reference Chart
Form Type Form Code Form Type Form Code Form Type Form Code
W2/W2C W 1099R R 1099G U
W2G G 1099M M 1099NEC N
*26124111694*
26124111694