Form It-40pnr - Schedules D & E - Exemptions/other Taxes - 2012
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1Schedules D & E
Schedule D: Exemptions
Enclosure
2012
Form IT-40PNR,
State Form 54032
(Schedule E begins after line 7 below)
Sequence No. 04
(R3 / 9-12)
Name(s) shown on Form IT-40PNR
Your Social Security Number
Round all entries
.00
1. Number of exemptions claimed on your federal return
x $1000 ____________________
1
• If you did not claim an exemption on your federal return, enter “1” in the box above.
• See instructions on page 31 if you did not fi le a federal return.
2. Claim an additional exemption for certain dependent children (see instructions).
.00
Enter number you are eligible to claim
x $1500: you MUST enclose Schedule IN-DEP __
2
3. Place “X” in box(es) below if, by December 31, 2012
You were age 65 or older
and/or blind
Spouse was 65 or older
and/or blind
.00
Total number of boxes with Xs
x $1000 _____________________________________
3
4. If age 65 or older, enter amount from Schedule A, line 37A $
If this amount is less than $40,000, place “X” in box(es) below if:
You were age 65 or older
Spouse was 65 or older
.00
Total number of boxes with Xs
x $500 ______________________________________
4
.00
5. Add lines 1, 2, 3 and 4 ___________________________________________________________
5
.
6. Enter the number from Schedule A, Proration Section, line 21D ___________________________
6
.00
7. Multiply line 5 by line 6. Enter here and on Form IT-40PNR, line 6 __________ Total Exemptions
7
Schedule E: Other Taxes
Instructions begin on page 32
.00
1. Use tax on out-of-state purchases from line 4 of Sales/Use Tax Worksheet __________________
1
.00
2. Household employment taxes. Enclose Schedule IN-H __________________________________
2
.00
3. Recapture of Indiana’s CollegeChoice 529 credit. Enclose Schedule IN-529R ________________
3
.00
4. Add lines 1 through 3. Enter here and on Form IT-40PNR, line 10.
Total Other Taxes
4
23712111694
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