Indiana Income/Loss, Proration & Adjustments to Income (Nonresident)

Income/Loss, Proration & Adjustments to Income (Nonresident)
Schedule A
Schedule A

Form IT-40PNR
State Form 48719
(R22 / 9-23)

Schedule A Section 1: Income or Loss
(Complete Proration, Section 2 and Section 3 on back)

Name(s) shown on Form IT-40PNR								

2023

Enclosure
Sequence No. 01
Page 1 of 2

Your Social Security Number

Section 1: Income or (Loss) Enter in Column A the same income or loss you reported on your 2023 federal income tax return, Form
1040, Form 1040-SR, and Form 1040 Schedule 1 (except for line 19B and/or a net operating loss carryforward on line 20B; see
instructions). Round all entries.
Column B
Column A
Income Taxed by Indiana
Income from Federal Return
1.	 Your wages, salaries, tips, commissions, etc______________	1A	.00	1B	.00
2.	 Spouse’s wages, salaries, tips, commissions, etc __________	2A	.00	2B	.00
3.	 Taxable interest income ______________________________	3A	.00	3B

	

.00

4.	 Dividend income ___________________________________	4A	.00	4B	.00
5.	 Taxable refunds, credits, or offsets of state
and local taxes from your federal return _________________	5A	.00	5B	.00
6.	 Alimony received ___________________________________	6A	.00	6B	.00	
7.	 Business income or loss from federal Schedule C _________	7A	.00	7B	.00
8.	 Capital gain or loss from sale or exchange
of property from your federal return_____________________	8A	.00	8B	.00
9.	 Other gains or (losses) from Form 4797 _________________	9A	.00	9B	.00
10.	 Taxable IRA distribution______________________________	10A	.00	10B	.00
11.	 Taxable pensions and annuities________________________	11A 	.00	11B	.00
12.	 Net rent or royalty income or loss reported on
federal Schedule E _________________________________	12A	.00	12B	.00
13.	 Income or loss from partnerships ______________________	13A	.00	13B	.00
14.	 Income or loss from trusts and estates__________________	14A	.00	14B	.00
15.	 Income or loss from S corporations _____________________	15A	.00	15B	.00
16.	 Farm income or loss from federal Schedule F_____________	16A	.00	16B	.00
17.	 Unemployment compensation _________________________	17A	.00	17B	.00
18.	 Taxable Social Security benefits________________________	18A	
.	00	18B	.00
19.	 Indiana apportioned income from
Schedule IT-40PNRA ____________________________________________________________	19B	.00
20.	 Other income reported on your federal return _____________	20A	.00	20B	.00
List source(s). (Do not include federal net operating loss in Column B. See instructions.)

21.	 Subtotal: add lines 1 through 20________________________	 21A	.00

*23423111694*
23423111694

	 21B	.00

Schedule A

Form IT-40PNR

Schedule A Proration;
Section 2: Adjustments to Income

2023

Enclosure
Sequence No. 01A
Page 2 of 2

Proration Section See instructions.
21C. Note: Nonresident military personnel see special instructions and complete worksheet_________ 	21C	.00
21D. For all other individuals, divide the amount on line 21B by the amount on line 21A (see instructions
if either line 21A and/or 21B are less than zero). Please round your answer to a decimal followed
by three numbers. Example: $3,100 ÷ $8,000 = .3875, which rounds to .388 (do not enter a
number greater than 1.00). Enter result here and on Schedule D, line 8__________________________ 	21D	

.

Section 2: Adjustments to Income Note: Enter in Column A only those deductions claimed on your 2023 federal income tax return,
	
Form 1040, Form 1040-SR, and Form 1040, Schedule 1, Part II. Round all entries.
Column A
Column B
Federal Adjustments
Indiana Adjustments
22.	Educator expenses (see instructions)__________________ 	22A	.00	22B	
.00
23.	Certain business expenses of reservists,
performing artists, etc______________________________ 	23A	.00	23B	.00
24.	Health savings account deduction_____________________ 	24A	.00	24B	.00
25.	Moving expenses (see instructions)____________________ 	25A	.00	25B	.00
26.	Deductible part of self-employment tax_________________ 	26A	.00	26B	.00
27.	Self-employed, SEP, SIMPLE, and qualified plans________ 	27A	.00	27B	.00
28.	Self-employed health insurance deduction______________ 	28A	.00	28B	.00
29.	Penalty on early withdrawal of savings_________________ 	29A	.00	29B	.00
30.	Alimony paid_____________________________________ 	30A	.00	30B	.00
31.	IRA deduction_____________________________________ 	31A	.00	31B	.00
32.	Student loan interest deduction (see instructions)_________ 	32A	.00	32B	.00
33.	Reserved for future use_____________________________ 	33A	

.00	

33B 	

.00

34.	Other (see instructions)		 34A	.00	34B	.00
35.	Add lines 22 through 34_____________________________ 	 35A	.00	

35B	.00

Section 3: Totals
36.	Subtract line 35 from line 21 of Section 1. Carry
amount from line 36B to Form IT-40PNR, line 1 __________ 	 36A	.00	

*23423121694*
23423121694

36B	.00