State Form 55629 - Schedule In-Occ - Other Certified Credits - 2014

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Other Certified Credits
Schedule IN-OCC
Enclosure
State Form 55629
Sequence No. 25
2014
(9-14)
Name shown on Form IT-40/IT-40PNR
Your Social Security Number
Name shown on IT-20/IT-20NP/IT-65/IT-20S/FIT-20
Federal ID Number
Complete this schedule if you are reporting any of the following credits:
Hoosier Business Investment Credit; Hoosier Business Investment - Logistics Credit; Natural Gas Commercial Vehicle Credit; School
Scholarship Credit.
Column A
Column B
Column C
Column D
Column E
IT-20S/IT65
Certification/
Federal ID# if Credit
Certification
Project
3-Digit
Amount
is from IN K-1
Year
Number
Code
Claimed
.00
1.
1
.00
2.
2
.00
3.
3
.00
4.
4
.00
5.
5
.00
6.
6
.00
7.
7
.00
8.
8
.00
9.
9
.00
10.
10
.00
11.
11
.00
12.
12
.00
13.
13
.00
14.
14
.00
15.
15
.00
16.
16
17. Add amounts from Column E, lines 1 - 16, and enter total here. Carry to the
appropriate line on: Schedule 6; Schedule G; Form IT-20; Form IT-20NP; or
.00
Form FIT-20 (Form IT-65 and Form IT-20S filers must see special reporting instructions) ____Total
17
*21514111694*
21514111694

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