Form It-65 - Indiana Partnership Return - 2012

Indiana Department of Revenue

Form IT-65

Indiana Partnership Return

2012

State Form 11800 (R11 / 8-12)

for Calendar Year Ending December 31, 2012

or Other Tax Year Beginning

2012 and Ending

Check box if amended.

Check box if name changed.

Federal Identification Number

Name of Partnership

Number and Street

Indiana County or O.O.S.

Principal Business Activity Code

Telephone Number

City

State

ZIP Code

K. Date of organization ____________________

O. Check all boxes that apply to entity:

Initial Return

Final Return

In Bankruptcy

Composite Return

In the State of _________________________

P. Enter total number of partners:

Enter number of nonresident partners:

Q. Do you have on file a valid extension of time to file your return

L. State of commercial domicile _____________

(federal Form 7004 or an electronic extension of time)?

Y

N

M. Year of initial Indiana return _______________

R. Are you a limited liability company electing partnership treatment on your federal return?

Y

N

N. Accounting method:

S. Is this partnership a member of any other partnership(s)?

Y

N

Cash

Accrual

Other

Aggregate Partnership Distributive Share Income (see worksheet)

Round all entries

1. Total net income (loss) from U.S. partnership return, Form 1065 Schedule K, lines 1 through 11 less line 12, and a portion of line 13

00

related to investment income (see instructions); use minus sign for negative amounts ......................................................................................

1

00

2a. Enter name of addback or deduction (see instructions) _________________________________________

Code No. _________

2a

00

2b. Enter name of addback or deduction ________________________________________________________

Code No. _________

2b

00

2c. Enter name of addback or deduction ________________________________________________________

Code No. _________

2c

00

2d. Enter name of addback or deduction ________________________________________________________

Code No. _________

2d

00

2e. Enter name of addback or deduction ________________________________________________________

Code No. _________

2e

00

2f.

Enter the total amount of addbacks and deductions from any additional sheets (use a minus sign for negative amount) ............................. 2f

00

3. Total partnership income, as adjusted (add lines 1 through 2f) ..........................................................................................................................

3

.

%

4. Enter percentage for Indiana apportioned adjusted gross income from IT-65 Schedule E line 9, if applicable .................................................

4

Summary of Calculations

00

5. Sales/use tax due on purchases subject to use tax from Sales/Use Tax worksheet (from page 20) .................................................................

5

00

6. Total composite tax from completed Schedule IT-65COMP (15G). Attach schedule ..........................................................................................

6

00

7. Total tax (add lines 5 and 6). Caution: If line 7 is zero, see line 12 late file penalty ............................................................................................

7

00

8. Total amount of withholding (attach WH-18 statement(s) for composite members) ...........................................................................................

8

00

9. Other payments/credits belonging to the partnership (attach documentation) ...................................................................................................

9

00

10. Subtotal (line 7 minus lines 8 and 9). If total is greater than zero, proceed to lines 11, 12, and 13 .....................................................................

10

00

11. Interest: Enter total interest due; see instructions (contact the Department for current interest rate) ...............................................................

11

00

12. Penalty: If paying late, enter 10% of line 10. If line 7 is zero, enter $10 per day filed past the due date; see instructions ................................

12

00

13. Penalty: If failing to include all nonresident partners on composite return, enter $500; see instructions ..........................................................

13

00

14. Total Amount Due (add lines 10 through 13). If less than zero, enter on line 15. Make payment in U.S. funds ................................................

14

00

15. Overpayment (line 8 plus line 9, minus lines 7, 11, 12, and 13) ..........................................................................................................................

15



00

16. Refund: Amount from line 15. No carryforward allowed. Enter as a positive figure ...........................................................................................

16

Certification of Signatures and Authorization Section

Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to the best of my knowledge

and belief it is true, correct, and complete.

I authorize the Department to discuss my return with my personal

Partnership's E-mail Address EE

representative (see page 12)

Y

N

Signature of Corporate Officer

Date

Paid Preparer: Firm’s Name (or yours if self-employed)

PTIN

Print or Type Name of Corporate Officer

Title

Personal Representative’s Name (Print or Type)

Telephone Number

Telephone Number

Address

City

Address

State

Zip Code + 4

City

State

Zip Code + 4

Paid Preparer’s Signature

Date

If you owe tax, please mail your return to IN Department of Revenue, PO Box 7205, Indianapolis, IN 46207-7205.

If you do not owe any tax, mail it to IN Department of Revenue, PO Box 7147, Indianapolis, IN 46207-7147.

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