Form It-41 - Fiduciary Income Tax Return
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1FORM
INDIANA DEPARTMENT OF REVENUE
IT-41
Revised 10-93
FIDUCIARY INCOME TAX RETURN
SF 11458
For the calendar year ________ or fiscal year beginning ________, 19________ and ending ________, 19________
Check Applicable Boxes
Federal Identification Number
Estate
Simple Trust
Name of Estate or Trust
Date Entity Created
Complex Trust
Bankruptcy Estate
Name and Title of Fiduciary
Date of Decedent's Death
Grantor Trust
If Trust, check which type.
Testamentary
Decedent's Social Security Number
Address
Inter vivos
Was final Individual Return
Grantor's Social Security Number:
filed for decedent?
Yes
No
City
State
Zip Code
Has an Indiana Inheritance
Number of Schedule K-1s
Tax Return been filed?
Yes
No
First Return
Final Return
Amended Return
Check
Attached (see instructions)
applicable
Is there a nonresident
Change in Fiduciary's
Name or
Address
Boxes
beneficiary?
Yes
No
INCOME
1.
Taxable Income of Fiduciary from Federal Form 1041 ..................................................................
1.
AND
INDIANA
2.
Federal Deductions Allocable to Tax-Exempt Income ...................................................................
2.
ADDITIONS
3.
Lump Sum Distribution from Federal Form 4972 ...........................................................................
3.
4.
Total Income (Add lines 1 through 3.) ............................................................................................
4.
5.
Interest on U.S. Obligations Reported on Federal Return .............................................................
5.
INDIANA
DEDUCTIONS
6.
Non-Indiana Fiduciary Income .......................................................................................................
6.
7.
State Taxable Income (Line 4 minus lines 5 and 6.) ......................................................................
7.
8.
State Adjusted Gross Income Tax (3.4% of line 7) ........................................................................
8.
TAX
COMPUTATIONS
9.
Additional Tax .................................................................................................................................
9.
10.
Total Tax (Add lines 8 and 9.) ........................................................................................................
10.
11.
Estimated Tax Paid .......................................................................................................................
11.
CREDITS
12.
Other Credits...................................................................................................................................
12.
13.
Total Credits (Add lines 11 and 12.) ...............................................................................................
13.
14.
Balance of Tax Due (If line 10 is greater than line 13, enter the difference.) .................................
14.
15.
15.
Penalty for Delinquent Payment (10% of line 14)............................................................................
16.
If Delinquent, Add Interest...........................................................................................................
16.
17.
Total Tax, Penalty and Interst (Add lines 14 through16)*................................PAYMENT DUE
17.
18.
Refund Due (If line 13 is greater than line 10, enter the difference.) ..............................REFUND
18.
* Make your check or money order payable to: INDIANA DEPARTMENT OF REVENUE.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is based upon all information of which the preparer
has any knowledge.
DO NOT WRITE
BELOW
Mail completed return to:
Signature of Fiduciary
Telephone Number
Date
19.
Indiana Department of
Revenue
Fiduciary Section
20.
P.O. Box 6079
Signature of Preparer
Telephone Number
Date
Indianapolis, IN 46206-6079
21.
Preparer's Address and Zip Code
Preparer's Identification Number
22.
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