Indiana Part-Year or Full-Year Nonresident Individual Income Tax Return

Part-Year or Full-Year Nonresident Individual Income Tax Return 
IT-40PNR Form
Indiana Part-Year or Full-Year Nonresident
Individual Income Tax Return

Form

IT-40PNR
State Form 472
(R22 / 9-23)

	

from	

to:		

Your Social
Security Number

Your first name

2023

If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY):

Due April 15, 2024
Place “X” in box
if amending

Spouse’s Social
Security Number
Place “X” in box if applying for ITIN
Initial
Last name

If filing a joint return, spouse’s first name

Initial

Place “X” in box if applying for ITIN
Suffix

Last name

Suffix

Present address (number and street or rural route)

City

State

Place “X” in box if you are
married filing separately.
ZIP/Postal code

Foreign country 2-character code (see instructions)

Enter below the 2-digit county code numbers (found on the back of Schedule CT-40PNR) for the county where you lived and
worked on Jan. 1, 2023.
County where
you lived

County where
you worked

County where
spouse lived

County where
spouse worked

1.	 Complete Schedule A first. Enter here the amount from Section 3, line 36B, and enclose
Schedule A_______________________________________________________ Indiana Income	

Round all entries
1	.00

2.	 Enter amount from Schedule B, line 6, and enclose Schedule B___________ Indiana Add-Backs	

2	.00

3.	 Add line 1 and line 2______________________________________________________________ 	

3	.00

4.	 Enter amount from Schedule C, line 12, and enclose Schedule C_________ Indiana Deductions	

4	.00

5.	 Subtract line 4 from line 3__________________________________________________________ 	

5	.00

6.	 You must complete Schedule D. Enter amount from Schedule D, line 9,
and enclose Schedule D _________________________________________ Indiana Exemptions	

6	.00

7.	 Subtract line 6 from line 5_______________________________ Indiana Adjusted Gross Income	 7	.00
8.	 State adjusted gross income tax: multiply line 7 by 3.15% (.0315)
(if answer is less than zero, leave blank)______________________ 	8	.00
9.	 County tax. Enter county tax due from Schedule CT-40PNR
(if answer is less than zero, leave blank)______________________ 	 9	.00
10.	 Other taxes. Enter amount from Schedule E, line 5 (enclose sch.)		 10	.00
11.	 Add lines 8, 9 and 10. Enter total here and on line 15 on the back______________ Indiana Taxes	 11	.00

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12.	 Enter credits from Schedule F, line 13 (enclose schedule)____ 	

12	.00

13.	 Enter offset credits from Schedule G, line 8 (enclose schedule)	

13	.00

14.	 Add lines 12 and 13 ________________________________________________ Indiana Credits	

14	.00

15.	 Enter amount from line 11___________________________________________ Indiana Taxes	

15	.00

16.	 If line 14 is equal to or more than line 15, subtract line 15 from line 14 (if smaller, skip to line 23)_ 	

16	.00

17.	 Enter donations from Schedule IN-DONATE (enclose schedule); cannot be greater than line 16	

17	.00

18.	 Subtract line 17 from line 16__________________________________________ Overpayment	

18	.00

19.	 Amount from line 18 to be applied to your 2024 estimated tax account (see instructions).
Enter your county code	

county tax to be applied___ $	

a	.00

Spouse’s county code	

county tax to be applied___ $	

b	.00

Indiana adjusted gross income tax to be applied___________ $	

c	.00

Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18)______ 	 19d	.00
20.	 Penalty for underpayment of estimated tax from Schedule IT-2210 and IT-2210A _____________ 	
a. Enter code A if annualizing. Enter Code F if Farmer or Fisherman ____________	

20	.00

a

21.	 Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 instructions_____ Your Refund	

21	.00

22.	 Direct Deposit (see instructions)
a. Routing Number
b. Account Number
c. Type:	

Checking 	

Savings	

Hoosier Works MC

d. Place an “X” in the box if refund will go to an account outside the United States
23.	 If line 15 is more than line 14, subtract line 14 from line 15. Add to this any amount on line 20
(see instructions)_______________________________________________________________ 	

23	.00

24.	 Penalty if filed after due date (see instructions)________________________________________ 	

24	.00

25.	 Interest if filed after due date (see instructions)________________________________________ 	

25	.00

26.	 Amount Due: Add lines 23, 24 and 25_______________________________ Amount You Owe	
Do not send cash. Please make your check or money order payable to:
Indiana Department of Revenue. See instructions if paying by credit card.

26	.00

Sign and date this return after reading the Authorization statement on Schedule H. You must enclose Schedule H (both pages).
_____________________________________________________ 	
Your Signature	
Date	

__________________________________________________
Spouse’s Signature	
Date

•	 If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN 46207-7224.
•	 Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

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