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Form It-20 - Schedule 8-D - Consolidated Income Tax Schedule For Indiana Affiliated Group Page 2

Indiana Department of Revenue

Part II

Consolidated Gross Income for Indiana Affiliated Group

Period Beginning month ______________ year _______ and Ending month ______________ year ______

Note: Those affiliated corporations incorporated or authorized to do business in Indiana may file consolidated gross income

returns. Income from intercompany sales of property and intercompany receipts in the form of interest, rentals, and dividends may

be eliminated. See instructions on page 4. Totals from this schedule should be carried to Form IT-20 Schedule A, Gross Income

Tax Calculation.

Reporting Corporation

Affiliated Corporation

Gross Income

No. ____

Name of Corporation

Name

List all Gross Receipts

A. 1.2%

B. .3%

A. 1.2%

B. .3%

1. Commissions and fees........................................

2. Interest and dividends.....................................

3. Rents, leases, and sales of real estate (without

d e d u c t i o n s ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Sale of securities and personal property (without

d e d u c t i o n s ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Gross earnings (see Form IT-20 instructions).........

6. Contractor receipts and other service receipts......

7. Other receipts - attach explanation.......................

8. Contractor's sale of materials...............................

9. Selling at retail.............................................

10. Laundering, dry cleaning, and industrial processing

(excluding receipts from coin operated equipment)

and commercial printing (excluding photocopying)...

11. Sales of agricultural products...............................

12. Manufacturer's sales at wholesale...................

13. Other sales at wholesale.................................

14. Total amounts (add lines 1-7 in Column A, and lines

8-13 in Column B) for each member.....................

Nontaxable Receipts

List all eliminations and other nontaxable receipts.

Total amounts (add entries in Columns A and B)

for each member.....................................................

Form It-20 - Schedule 8-D - Consolidated Income Tax Schedule For Indiana Affiliated Group Page 2