Form It-40rnr - Reciprocal Nonresident Indiana Individual Income Tax Return - 2015
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1
2Reciprocal Nonresident Indiana
Form
IT-40RNR
2015
Individual Income Tax Return
State Form 44406
Due April 18, 2016
(R14 / 9-15)
Your Social
Spouse’s Social
Check the box if you are
Security Number
Security Number
married filing separately.
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)
Foreign country
2-character code
City
State
Zip/Postal code
If any individual listed above died during
2015, enter date of death below (MMDD).
Enter the 2-digit code numbers (see instructions) for the county and/or state where you lived
Taxpayer's
2015
and worked on January 1, 2015.
date of death
Yourself
Spouse
Spouse’s
2015
State where
County where
State where
County where
date of death
you lived
you lived
you worked
you worked
Your State of Residence: Check the appropriate box to indicate your state of residence for 2015.
Important: You must file
Kentucky
Michigan
Ohio
Pennsylvania
Wisconsin
Form IT-40PNR if you have
Note: You must file Form IT-40PNR, Part-Year Resident or Nonresident Indiana Individual Income Tax
Indiana riverboat winnings.
Return, if you were a resident of a state other than those listed; had Indiana income other than wages,
salaries, tips or commissions; or were a part-year resident of Indiana during 2015.
Read Instructions First
Yours (A)
Spouse's (B)
00
00
1. Enter gross income from your Indiana employment .................. 1A
1B
00
00
2. Allowable deductions: attach front page of federal Form 1040 ... 2A
2B
00
00
3. Indiana adjusted gross income: line 1 minus line 2 ..................... 3A
3B
00
00
4. Exemptions: see instructions ...................................................... 4A
4B
00
00
5. Taxable income: line 3 minus line 4 (see instructions) ................ 5A
5B
.
.
6. County nonresident rate from chart (see instructions) ................ 6A
6B
00
00
7. County tax due: multiply line 5 x line 6 ....................................... 7A
7B
00
8. Total county tax due: add lines 7A and 7B ......................................................................... Total Tax
8
00
9. Indiana state tax withheld: attach W-2 forms ....................................................................................
9
00
10. Indiana county tax withheld: attach W-2 forms ................................................................................... 10
Your W-2(s) showing Indiana state and county taxes withheld must be enclosed.
00
11. Add lines 9 and 10 .......................................................................................................Total Credits 11
12. Overpayment: if line 11 is more than line 8, subtract line 8 from line 11 and enter amount to be
00
refunded to you ............................................................................................................ Your Refund 12
13. a. Routing Number
c. Type:
Checking
Savings
Direct
Deposit
b. Account Number
(see instructions)
d. Place an “X” in the box if refund will go to an account outside the United States
00
14. Subtract line 11 from line 8 ................................................................................................................. 14
00
15. Penalty if filed after the due date (see instructions) ........................................................................... 15
00
16. Interest if filed after the due date (see instructions) ........................................................................... 16
00
17. Total amount you owe: add lines 14, 15 and 16 ................................................... Amount You Owe 17
Do not send cash. Please make your check or money order payable to:
Indiana Department of Revenue. See instructions if paying by credit card or electronic check.
*16015111694*
16015111694
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