Form It-20s - Schedule In K-1 - Shareholders'S Share Of Indiana Adjusted Gross Income, Deductions, Modifications, And Credits - 2009

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IT-20S
2009 Schedule IN K-1
State Form 49193 (R8/8-09)
Indiana Department of Revenue
Shareholders's Share of Indiana Adjusted Gross Income, Deductions, Modifications, and Credits
Tax Year Beginning
_____________/________/ 2009 and Ending
_____________/________/ __________
Name of Corporation
Federal Identification Number
Distributions - Provide IN K-1 to each shareholder. Attach IN K-1 to IT-20S return. For information on the
acceptable electronic data file format, visit the Department’s Web site at Pro rata
amounts for lines 1 through 14 of any nonresident shareholder must be multiplied by the Indiana apportion-
ment percent, if applicable, from IT-20S, line 4.
Part 1 – Shareholder's Identification Section
(a) If Shareholder Is an Individual (please print clearly)
Social Security Number:
Last Name:
First Name:
a3
a1
a2
(b) If Shareholder Is an Other Entity (please print clearly)
Federal Identification Number:
Name:
b1
b2
(c) Shareholder’s State of Residence or Commercial Domicile ...........................................................................c1
00
(d) Indiana Tax Withheld for Nonresident Shareholder (on WH-18) ..................................................................... d
.
%
(e) Shareholder’s Federal Pro Rata Percentage ................................................................................................. e
(f) Shareholder’s Tax as Computed on IT-20SCOMP Column G ......................................................................... f
00
Part 2 - Distributive Share Amount
(use apportioned figures for nonresident shareholders)
00
1. Ordinary business income (loss) .........................................................................................................................
00
2. Net rental real estate income (loss) .....................................................................................................................
00
3. Other net rental income (loss) .............................................................................................................................
00
4. Interest income ....................................................................................................................................................
00
5. Ordinary dividends ..............................................................................................................................................
00
6. Royalties ...........................................................................................................................................................
00
7. Net short-term capital gain (loss) ........................................................................................................................
00
8. Net long-term capital gain (loss) ..........................................................................................................................
00
9. Net IRC Section 1231 gain (loss) .......................................................................................................................
00
10. Other income (loss) ............................................................................................................................................
00
11. IRC Section 179 expense deduction ...................................................................................................................
12a.Portion of expenses related to investment portfolio income, including investment interest expense
00
and other (federal nonitemized) deductions ........................................................................................................
12b.Other information from line 17 of federal K-1 related to investment interest and expenses
00
not listed elsewhere .............................................................................................................................................
13. Total pro rata distributions (Add lines 1 through 10; subtract lines 11, 12a, and 12b when applicable.) ........
00
Continued on next page
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