Form It-40pnr - Schedule F: Credits - 2016

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Schedule F: Credits
Schedule F/Schedule IN-DONATE
Enclosure
2016
Form IT-40PNR,
Sequence No. 05
State Form 54033
(R7 / 9-16)
Name(s) shown on Form IT-40PNR
Your Social Security Number
Round all entries
.00
1. Indiana state tax withheld: enclose W-2s and/or 1099s showing state tax withholding amounts __
1
.00
2. Indiana county tax withheld: enclose W-2s and/or 1099s showing county tax withholding amts. __
2
.00
3. Estimated tax paid for 2016: include any extension payment made with Form IT-9 ____________
3
.00
4. Unified tax credit for the elderly ____________________________________________________
4
5. Earned income credit: see instructions
Enter earned income credit from
.00
Schedule IN-EIC, line A-3 _____________________________ Box A
.
Enter number from Schedule A, Proration Section, line 21D __________ Box B
.00
Multiply Box A by Box B, enter total here ___________________________________________
5
.00
6. Lake County residential income tax credit ____________________________________________
6
7. Economic development for a growing economy credit. Enter amount from Schedule IN-EDGE,
.00
line 19 (enclose schedule) ________________________________________________________
7
8. Economic development for a growing economy retention credit. Enter amount from
.00
Schedule IN-EDGE-R, line 19 (enclose schedule) ______________________________________
8
.00
9. Add lines 1 through 8. Enter total here and on Form IT-40PNR, line 12 __________ Total Credits
9
Schedule IN-DONATE
Important. The amount on line 2 cannot exceed the amount on Form IT-40/IT-40PNR, line 16.
1. Donations: List fund name, 3-digit code and amount to be donated (see instructions)
.00
a. Enter fund name
code no.
1a
.00
b. Enter fund name
code no.
1b
.00
c. Enter fund name
code no.
1c
.00
d. Enter fund name
code no.
1d
.00
2. Add lines 1a through 1d. Enter total here and on Form IT-40/IT-40PNR, line 17 Total Donations
2
*23816111694*
23816111694

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