Schedule 5 (Form It-40) - Credits - 2013

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Schedule 5
Schedule 5: Credits
Enclosure
2013
Form IT-40,
State Form 53998
Sequence No. 04
Instructions begin on page 28
(R4 / 9-13)
Name(s) shown on Form IT-40
Your Social Security Number
Round all entries
.00
1. Indiana state tax withheld: enclose W-2s, 1099s showing state tax withholding amounts ________
1
.00
2. Indiana county tax withheld: enclose W-2s, 1099s showing county tax withholding amounts _____
2
.00
3. Estimated tax paid for 2013: include any extension payment made with Form IT-9 ____________
3
.00
4. Unifi ed tax credit for the elderly ____________________________________________________
4
.00
5. Earned income credit: enclose Schedule IN-EIC and enter amount from line A-3 _____________
5
.00
6. Lake County residential income tax credit ____________________________________________
6
7. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,
.00
line 19 (enclose schedule) ________________________________________________________
7
8. Economic development for a growing economy retention credit. Enter amount from
.00
Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________
8
.00
9. Add lines 1 through 8. Enter total here and on Form IT-40, line 12 ______________ Total Credits
9

23113111694

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