Form IT-65
Indiana Department of Revenue
Indiana Partnership Return
State Form 11800 (R8/8-09)
for Calendar Year Ending December 31, 2009
or Other Tax Year Beginning ________/_______/ 2009 and Ending ________/________/ ________
Check box if amended.
Check box if name changed.
Federal Identification Number
Name of Partnership
Number and Street
Indiana County or O.O.S.
Principal Business Activity Code
Telephone Number
City
State
ZIP Code
(
)
K. Date of organization
O. Check all boxes that apply to entity:
Initial Return
Final Return
In Bankruptcy
Composite Return
In the State of
P. Enter total number of partners:
Enter number of nonresident partners:
Q. Do you have on file a valid extension of time to file your return
L. State of commercial domicile
(federal Form 7004 or an electronic extension of time)?
Y
N
M. Year of initial Indiana return
R. Are you a limited liability company electing partnership treatment on your federal return?
Y
N
N. Accounting method:
S. Is this partnership a member of any other partnership(s)?
Y
N
Cash
Accrual
Other
Aggregate Partnership Distributive Share Income (see worksheet)
Round all entries
1.
Total net income (loss) from U.S. partnership return, Form 1065 Schedule K, lines 1 through 11
00
less line 12, and a portion of line 13 related to investment income (see instructions) ......................................................................................
1
●
00
2a. Enter name of addback or deduction (see instructions) _________________________________________
Code No. _________
2a
●
00
2b. Enter name of addback or deduction ________________________________________________________
Code No. _________
2b
●
00
2c. Enter name of addback or deduction ________________________________________________________
Code No. _________
2c
●
2d. Enter name of addback or deduction ________________________________________________________
Code No. _________
2d
00
●
2e. Enter name of addback or deduction ________________________________________________________
Code No. _________
2e
00
●
00
2f.
Enter the total amount of addbacks and deductions from any additional sheets (enter negative amount in <brackets>) ............................... 2f
●
00
3.
Total partnership income, as adjusted (add lines 1 through 2f) .......................................................................................................................
3
●
.
4.
Enter average percentage for Indiana apportioned adjusted gross income from IT-65 Schedule E line (4c), if applicable ............................
4
%
Summary of Calculations
00
5.
Sales/use tax due on purchases subject to use tax from Sales/Use Tax worksheet (from page 19)...............................................................
5
●
00
6.
Total composite tax from completed Schedule IT-65COMP (15G). Attach schedule .......................................................................................
6
●
00
7.
Total tax (add lines 5 and 6). Caution: If line 7 is zero, see line 12 late file penalty .........................................................................................
7
●
00
8.
Total amount of withholding (attach WH-18 statement(s) for composite members) ........................................................................................
8
●
00
9.
Other payments/credits belonging to the partnership (attach documentation) ................................................................................................
9
●
10. Subtotal (line 7 minus lines 8 and 9). If total is greater than zero, proceed to lines 11, 12, and 13 .................................................................. 10
00
●
11. Interest: Enter total interest due; see instructions (contact the Department for current interest rate) ............................................................ 11
00
●
00
12. Penalty: If paying late, enter 10% of line 10. If line 7 is zero, enter $10 per day filed past the due date; see instructions ............................. 12
●
00
13. Penalty: If failing to include all nonresident partners on composite return, enter $500; see instructions....................................................... 13
●
14. Total Amount Due (add lines 10 through 13). If less than zero, enter on line 15. Make payment in U.S. funds............................................. 14
00
●
15. Overpayment (line 8 plus line 9, minus lines 7, 11, 12, and 13) ....................................................................................................................... 15
00
●
00
16. Refund: Amount from line 15. No carryforward allowed. Enter as a positive figure ........................................................................................ 16
●
Certification of Signatures and Authorization Section
Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to the best of my knowledge
and belief it is true, correct, and complete.
Corporation's Email Address EE
I authorize the Department to discuss my return with my personal
Y
N
representative (see page 11)
Signature of Corporate Officer
Date
Paid Preparer: Firm’s Name (or yours if self-employed)
Check One:
Federal ID Number
PTIN OR
Social Security Number
Print or Type Name of Corporate Officer
Title
Personal Representative’s Name (Print or Type)
Telephone Number
Address
Telephone Number
Address
City
State
City
Zip Code + 4
State
Zip Code + 4
Paid Preparer's Signature
Date
Please mail forms to: Indiana Department of Revenue 100 N. Senate Ave. Indianapolis, IN 46204-2253
*122091101*
122091101
VN