Form It-40pnr - Indiana Part-Year Or Full-Year Nonresident Individual Income Tax Return - 2015

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Indiana Part-Year or Full-Year Nonresident
Form
2015
IT-40PNR
Individual Income Tax Return
State Form 472
(R14 / 9-15)
If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY):
Due April 18, 2016
from
to:
Your Social
Spouse’s Social
Security Number
Security Number
Place “X” in box if applying for ITIN
Place “X” in box if applying for ITIN
Your first name
Initial
Last name
Suffix
If filing a joint return, spouse’s first name
Initial
Last name
Suffix
Present address (number and street or rural route)
Place “X” in box if you are
married filing separately.
City
State
Zip/Postal code
Foreign country 2-character code (see instructions)
School corporation number (see instructions)
Enter below the 2-digit county code numbers (found on the back of Schedule CT-40PNR) for the county where you lived and
worked on January 1, 2015.
County where
County where
County where
County where
you lived
you worked
spouse worked
spouse lived
Round all entries
1. Complete Schedule A first. Enter here the amount from Section 3, line 37B, and enclose
.00
Schedule A ______________________________________________________ Indiana Income
1
.00
2. Enter amount from Schedule B, line 6, and enclose Schedule B __________ Indiana Add-Backs
2
.00
3. Add line 1 and line 2 _____________________________________________________________
3
.00
4. Enter amount from Schedule C, line 12, and enclose Schedule C ________ Indiana Deductions
4
.00
5. Subtract line 4 from line 3 ____________________________________ Indiana Adjusted Income
5
6. You must complete Schedule D. Enter amount from Schedule D, line 7,
.00
and enclose Schedule D _______________________________________ Indiana Exemptions
6
.00
7. Subtract line 6 from line 5 _______________________________________State Taxable Income
7
8. State adjusted gross income tax: multiply line 7 by 3.3% (.033)
.00
(if answer is less than zero, leave blank) _____________________
8
9. County tax. Enter county tax due from Schedule CT-40PNR
.00
(if answer is less than zero, leave blank) _____________________
9
.00
10. Other taxes. Enter amount from Schedule E, line 4 (enclose sch.)
10
.00
11. Add lines 8, 9 and 10. Enter total here and on line 15 on the back _____________ Indiana Taxes
11
*15715111694*
15715111694

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