Form It-40rnr - Reciprocal Nonresident Indiana Individual Income Tax Return - 2009

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Reciprocal Nonresident Indiana
Form
IT-40RNR
2009
Individual Income Tax Return
State Form 44406
Due April 15, 2010
R8 / 9-09
Your Social
Spouse’s Social
Check the box if you are
Security Number
Security Number
married filing separately.
Your first name
Initial
Last name
If filing a joint return, spouse’s first name
Initial
Last name
Present address (number and street or rural route)
Foreign Country
(if applicable)
City
State
Zip Code + 4
If any individual listed above died during
2009, enter date of death below (MMDD).
Enter the 2-digit code numbers (see instructions) for the county and/or state where you lived
Taxpayer's
2009
and worked on January 1, 2009 (see back of form if you worked in Lake County).
date of death
Yourself
Spouse
Spouse’s
State where
County where
State where
County where
2009
date of death
you lived
you lived
you worked
you worked
Your State of Residence: Check the appropriate box to indicate your state of residence for 2009.
Kentucky
Michigan
Ohio
Pennsylvania
Wisconsin
Important: You must file
Form IT-40PNR if you have
Note: You must file Form IT-40PNR, Part-Year Resident or Nonresident Indiana Individual Income Tax
Indiana riverboat winnings.
Return, if you were a resident of a state other than those listed; had Indiana income other than wages,
salaries, tips or commissions; or were a part-year resident of Indiana during 2009.
Read Instructions First
Yours (A)
Spouse's (B)
00
00
1. Enter gross income from your Indiana employment .................. 1A
1B
00
00
2. Allowable deductions: attach front page of federal Form 1040 ... 2A
2B
00
00
3. Indiana adjusted gross income: line 1 minus line 2 ..................... 3A
3B
00
00
4. Exemptions: see instructions ...................................................... 4A
4B
.
.
00
00
5. Taxable income: line 3 minus line 4 ............................................ 5A
5B
6. County tax nonresident rate from chart (see instructions)........... 6A
6B
00
00
7. County tax due: multiply line 5 x line 6 ....................................... 7A
7B
00
8. Total county tax due: add lines 7A and 7B ......................................................................... Total Tax
8
00
9. Indiana state tax withheld: attach W-2 forms ....................................................................................
9
00
10. Indiana county tax withheld: attach W-2 forms ................................................................................... 10
Your W-2(s) showing Indiana state and county taxes withheld must be enclosed.
00
11. Add lines 9 and 10 .......................................................................................................Total Credits 11
12. Overpayment: if line 11 is more than line 8, subtract line 8 from line 11 and enter amount to be
00
refunded to you. No refund will be issued for less than $1........................................... Your Refund 12
Direct
13. a. Routing Number
c. Type:
Checking
Savings
Deposit
(see instructions)
b. Account Number
00
14. Subtract line 11 from line 8 ................................................................................................................. 14
00
15. Penalty if filed after the due date (see instructions) ........................................................................... 15
00
16. Interest if filed after the due date (see instructions) ........................................................................... 16
00
17. Total amount you owe: add lines 14, 15 and 16 ................................................... Amount You Owe 17
No payment is due if you owe less than $1. Do not send cash. Please make your check or money
order payable to: Indiana Department of Revenue. See instructions if paying by credit card or
electronic check.
*160091101*
160091101

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