Indiana Additional Required Information

Additional Required Information
Schedule 7
Schedule 7: Additional Required Information

Schedule 7

Form IT-40, State Form 54000
(R14 / 9-23)

Name(s) shown on Form IT-40								

1. Federal filing information
Are you filing a federal income tax return for 2023? Place “X” in appropriate box.	Yes

2023

Enclosure
Sequence No. 06

Your Social Security Number

	

No

2. Out-of-state income: Complete if you and/or your spouse (if filing a joint return) received any salary, wage, tip and/or commission
income from Illinois, Kentucky, Michigan, Ohio, Pennsylvania or Wisconsin. Enter two-digit code number from the back of Schedule CT-40
for state where you and/or your spouse worked.
State where you worked	

Your income	

State where spouse worked	

Spouse’s income

	$	
.00	$	
.00
3. Extension of time to file
	 a. Place “X” in box if you have filed a federal extension of time to file, Form 4868, or made an online extension payment.
	
	 b. Place “X” in box if you have filed an Indiana extension of time to file, Form IT-9, or made an Indiana extension payment online.
4. Farm/Fishing income
Place “X” in box if at least two-thirds of your gross income was made from farming or fishing.
Important: If you placed an “X” in the box, you MUST attach Schedule IT-2210.
5. Schedule IN-40PA filers. If you are eligible to file federal Form 8857, Request for Innocent Spouse Relief, and are completing
Indiana Schedule IN-40PA, enclose Schedule IN-40PA and check the box.
6. Date of death
If any individual listed at the top of the IT-40 died during 2023, enter date of death (MM/DD).
	

2023

Taxpayer’s date of death	

Spouse’s date of death	

2023

Authorization: Sign Form IT-40 after reading the following statement.
Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, complete and correct. I understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for all
taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of
Revenue (DOR) to furnish my financial institution with my routing number, account number, account type and Social Security number to
ensure my refund is properly deposited. I grant permission to DOR to contact the Social Security Administration to confirm that the
Social Security number(s) used on this return is correct.
7.	Your daytime	
	 telephone number	

Your
email address	

I authorize the Department to discuss my return with my
personal representative.
	Yes	

No	

Paid Preparer: Firm’s Name (or yours if self-employed)

If yes, complete the information below.

Personal Representative’s Name (please print)

	

IN-OPT on file with paid preparer if not filing electronically

PTIN

Telephone
number

Address

Address

City

City

State	
ZIP Code
Preparer’s
signature__________________________________________

State	

ZIP Code

*23323111694*
23323111694