Indiana Additional Dependent Child Information

Additional Dependent Child Information
Schedule IN-DEP
Schedule IN-DEP

Form IT-40/IT-40PNR
State Form 54815
(R13 / 9-24)

Indiana Department of Revenue

Dependent Information and Additional
Dependent Child Information

Name(s) shown on Form IT-40/IT-40PNR

Your Social Security Number

Dependent’s First Name
1A.	

2024

Enclosure
Sequence No. 03A/04A

Dependent’s Last Name
1B.	

Dependent’s Social Security Number

Dependent’s Date of Birth (mm dd yyyy)

1C.	
1D.	
1E.	 Place “X” in box 1E if claiming dependent as an additional dependent child exemption____________________ 	1E
1F.	 Place “X” in box 1F if dependent child claimed for the first time (see instructions)________________________ 	1F
Dependent’s First Name
2A.	

Dependent’s Last Name
2B.	

Dependent’s Social Security Number

Dependent’s Date of Birth (mm dd yyyy)

2C.	
2D.	
2E.	 Place “X” in box 2E if claiming dependent as an additional dependent child exemption____________________ 	2E
2F.	 Place “X” in box 2F if dependent child claimed for the first time (see instructions)________________________ 	2F
Dependent’s First Name
3A.	

Dependent’s Last Name
3B.	

Dependent’s Social Security Number

Dependent’s Date of Birth (mm dd yyyy)

3C.	
3D.	
3E.	 Place “X” in box 3E if claiming dependent as an additional dependent child exemption____________________ 	3E
3F.	 Place “X” in box 3F if dependent child claimed for the first time (see instructions)________________________ 	3F
Dependent’s First Name
4A.	

Dependent’s Last Name
4B.	

Dependent’s Social Security Number

Dependent’s Date of Birth (mm dd yyyy)

4C.	
4D.	
4E.	 Place “X” in box 4E if claiming dependent as an additional dependent child exemption____________________ 	4E
4F.	 Place “X” in box 4F if dependent child claimed for the first time (see instructions)________________________ 	4F
5. Dependent Exemptions. Add the number of dependents listed above (see instructions). Enter the total
here and in the box on line 2 of Schedule 3 (if filing Form IT-40) or Schedule D (if filing Form IT-40PNR)______ Box 5
6. Additional Dependent Exemptions. Add the total number of boxes with Xs from lines 1E,1F, 2E, 2F, 3E, 3F,
4E and 4F if applicable. Enter the total here and in the box on line 3 of Schedule 3 (if filing Form IT-40)
or Schedule D (if filing Form IT-40PNR)_________________________________________________________ Box 6

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