Form
IT-40
State Form 154
(R21 / 9-22)
Your Social Security Number
Your first name
2022 |
Indiana Full-Year Resident |
Due April 18, 2023 |
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Individual Income Tax Return |
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If filing for a fiscal year, enter the dates (see instructions) (MM/DD/YYYY):
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Place “X” in box |
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from |
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to: |
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if amending |
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Spouse’s Social |
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Security Number |
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Place “X” in box if applying for ITIN |
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Place “X” in box if applying for ITIN |
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Initial |
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Last name |
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Suffix |
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If filing a joint return, spouse’s first name |
Initial |
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Last name |
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Suffix |
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Present address (number and street or rural route) |
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Place “X” in box if you are |
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married filing separately. |
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City |
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State |
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ZIP/Postal code |
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Foreign country 2-character code (see instructions)
Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and worked on Jan. 1, 2022.
County where spouse lived
County where spouse worked
1. |
Enter your federal adjusted gross income from your federal |
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income tax return, Form 1040 or Form 1040-SR, line 11 _____________________ Federal AGI |
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1 |
2. |
Enter amount from Schedule 1, line 7, and enclose Schedule 1 ________ |
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2 |
Indiana Add-Backs |
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3. |
Add line 1 and line 2 ____________________________________________________________ |
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3 |
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4. |
Enter amount from Schedule 2, line 12, and enclose Schedule 2 _______ Indiana Deductions |
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4 |
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5. |
Subtract line 4 from line 3 ________________________________________________________ |
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5 |
6. |
Complete Schedule 3. Enter amount from Schedule 3, line 7, |
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and enclose Schedule 3 ______________________________________ Indiana Exemptions |
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6 |
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7. |
Subtract line 6 from line 5 ____________________________ Indiana Adjusted Gross Income |
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7 |
8. |
State adjusted gross income tax: multiply line 7 by 3.23% (.0323) |
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(if answer is less than zero, leave blank) ____________________ |
8 |
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.00 |
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9. |
County tax. Enter county tax due from Schedule CT-40 |
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(if answer is less than zero, leave blank) ____________________ |
9 |
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.00 |
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10. |
Other taxes. Enter amount from Schedule 4, line 4 (enclose schedule) |
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10 |
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.00 |
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11. |
Add lines 8, 9 and 10. Enter total here and on line 15 on the back ___________ Indiana Taxes |
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11 |
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.00

*15122111694*
15122111694
12. |
Enter credits from Schedule 5, line 12 (enclose schedule) ___ |
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12 |
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.00 |
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13. |
Enter offset credits from Schedule 6, line 8 (enclose schedule) |
13 |
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.00 |
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14. |
Add lines 12 and 13 ______________________________________________ Indiana Credits |
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14 |
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.00 |
15. |
Enter amount from line 11___________________________________________ Indiana Taxes |
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15 |
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.00 |
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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 |
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.00 |
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17. |
Enter donations from Schedule IN-DONATE (enclose schedule); cannot be greater than line16 |
17 |
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.00 |
18. |
Subtract line 17 from line 16 __________________________________________Overpayment |
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18 |
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.00 |
19. |
Amount from line 18 to be applied to your 2023 estimated tax account (see instructions). |
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Enter your county code |
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county tax to be applied _ $ |
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a |
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.00 |
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Spouse’s county code |
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county tax to be applied _ $ |
b |
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.00 |
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Indiana adjusted gross income tax to be applied _________ $ |
c |
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.00 |
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Total to be applied to your estimated tax account (a + b + c; cannot be more than line 18)_____ |
19d |
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.00 |
20. |
Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A ____________ |
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20 |
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.00 |
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Refund: Line 18 minus lines 19d and 20. Note: If less than zero, see line 23 |
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21. |
___ Your Refund |
21 |
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.00 |
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22.Direct Deposit (see instructions)
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a. Routing Number |
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b. Account Number |
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c. Type: |
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Checking |
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Savings |
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Hoosier Works MC |
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d. Place an “X” in the box if refund will go to an account outside the United States |
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23. |
If line 15 is more than line 14, subtract line 14 from line 15. Add any amount to this on line 20 |
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(see instructions) _____________________________________________________________ |
23 |
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.00 |
24. |
Penalty if filed after due date (see instructions) ______________________________________ |
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24 |
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.00 |
25. |
Interest if filed after due date (see instructions) ______________________________________ |
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25 |
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.00 |
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Amount Due: Add lines 23, 24 and 25______________________________ Amount You Owe |
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26. |
26 |
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.00 |
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Do not send cash. Make your check or money order payable to: |
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Indiana Department of Revenue. See instructions if paying with a credit card. |
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Sign and date this return after reading the Authorization statement on Schedule 7. Remember to enclose Schedule 7.
_____________________________________________________ |
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Signature |
Date |
Spouse’s Signature |
Date |
•Mail payments 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.
*15122121694*
15122121694