Form 48684 - Schedule In-H - Indiana Household Employment Taxes - 2010

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Indiana Household Employment Taxes
Schedule IN-H
Enclosure
State Form 48684
2010
Sequence No. 12
Attach to Form IT-40, Form IT-40PNR or Form IT-40P
(R4 / 9-10)
This schedule should be filed by an individual who:
withholds state and county (if applicable) tax on household employees, AND
pays those withholding taxes with the filing of his/her individual income tax return.
Name of employer (as shown on individual income tax return)
Employer Social Security Number
Employer Federal Identification Number
A
Did you file federal Schedule H for the tax year shown above?
Yes. Go to question B.
No.
Stop. Do not file this schedule.
B
Did you withhold state and/or county income tax for any household employee?
Yes. Complete Part II on the back of this schedule.
No.
Stop. Do not file this schedule.
C
Make sure you enclose the state copy of your employee's W-2 forms.
Complete Part II first. Carry those totals to the Part I Summary below.
Part 1:
Summary of Household Employment Taxes
.00
1. Enter the total State Tax withheld from Part II, line 2 ____________________________
1
.00
2. Enter the total County Tax withheld from Part II, line 3 __________________________
2
.00
3. Add lines 1 and 2. Enter the total here ______________________________________
3
Enter this amount on your Indiana individual income tax return on the following lines:
• Form IT-40 Schedule 4, line 2,
• Form IT-40PNR Schedule E, line 2.
Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements and W-2 forms,
and to the best of my knowledge and belief it is true, correct and complete.
___________________________________
______________________
___________
Employer's signature
Daytime telephone number
Date
*17310111694*
17310111694

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