Form It-20np - Indiana Nonprofit Organization Unrelated Business Income Tax Return - 2012 Page 2
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3IT-20NP 2012
Indiana Department of Revenue
Indiana Nonprofit Organization Unrelated Business Income
Additional Explanation or Adjustment
State Form 49189
(R11 / 8-12)
Line (a)
Explanation (b)
Amount (c)
Certification of Signatures and Authorization Section
Under penalties of perjury, I declare I have examined this return, including all accompanying schedules and statements, and to the best of my knowledge and belief it is true,
correct, and complete.
I authorize the Department to discuss my return with my personal representative (see page 11)
Yes
No
Organization's E-mail address EE
Paid Preparer: Firm’s Name (or yours if self-employed)
Signature of Officer
Date
PTIN
Print or Type Name of Officer
Title
Telephone Number
Personal Representative’s Name (Print or Type)
Address
Telephone Number
City
Address
State
ZIP Code + 4
City
State ZIP Code + 4
Paid Preparer's Signature
Date
Sales/Use Tax Worksheet
List all purchases made during 2012 from out-of-state companies.
Column A
Column B
Column C
Description of personal property purchased from
Date of Purchase(s)
Purchase Price
out-of-state retailer
Magazine subscriptions:
Mail order purchases:
Internet purchases:
Other purchases:
1. Total purchase price of property subject to the sales/use tax .............................................................
1C
2. Sales/use tax: Multiply line 1 by .07 (7%) ...........................................................................................
2C
3. Sales tax previously paid on the above items (up to 7% per item) .....................................................
3C
4. Total amount due: Subtract line 3 from line 2. Carry to Form IT-20NP, line 16. If the amount is
negative, enter zero and put no entry on line 16 of the IT-20NP . ..........................................................
4C
Please mail your forms to:
Indiana Department of Revenue
PO Box 7228
Indianapolis, IN 46207-7228
*24100000000*
24100000000
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