Form It-40pnr - Indiana Part-Year Or Full-Year Nonresident Individual Income Tax Return - 2012

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Form
Indiana Part-Year or Full-Year Nonresident
IT-40PNR
2012
Individual Income Tax Return
State Form 472
(R11 / 9-12)
If fi ling for a fi scal year, enter the dates (see instructions) (MM/DD/YYYY):
Due April 15, 2013
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 fi rst name
Initial
Last name
Suffi x
If fi ling a joint return, spouse’s fi rst name
Initial
Last name
Suffi x
Present address (number and street or rural route)
Place “X” in box if you are
married fi ling separately.
City
State
Zip/Postal code
Foreign country 2-character code (see pg. 5
)
School corporation number (see pages 61 and 62 )
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, 2012.
County where
County where
County where
County where
you lived
you worked
spouse worked
spouse lived
Round all entries
1. Complete Schedule A fi rst. 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 3.4% (.034)
.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 16 on the back _____________ Indiana Taxes
11

15712111694

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