2015 Indiana State Income Tax Return Electronic Filing Questionnaire

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Appendix A
State Questionnaire
2015 Indiana State Income Tax Return Electronic Filing Questionnaire
Residency Information
1. What Indiana County did you live in on January 1, 2015?
____________________
2. What Indiana County did you work in on January 1, 2015?
____________________
3. What Indiana County did your spouse live in on January 1, 2015?
____________________
4. What Indiana County did your spouse work in on January 1, 2015? ____________________
5. What School Corporation did you live in on January 1, 2015?
____________________
Indiana Deduction Information
6. Did you rent your home in 2015?
Yes_____*
No_____
*If yes, answer the following questions:
-How much rent did you pay per month?
$__________
-How many months during 2015 did you pay rent?
__________
-Landlord’s Name/ Address (if different from tax return):
_________________________________________________________________________
_________________________________________________________________________
7. Did you own/are buying your Indiana home in 2015?
Yes_____*
No_____
*If yes, answer the following question:
-What was the amount of Indiana property tax paid?
$__________
Miscellaneous Income Information
8. Did you receive prize money from the Hoosier Lottery?
Yes_____
No_____
9. Did you receive military pay?
Yes_____*
No_____
*If yes, answer the following questions:
-Were you receiving Active Duty (AD), Retirement (R), or Survivor’s Benefits (SB) pay?
AD_____
R______
SB_____
-If you received military retirement pay, were you at least 60 years of age by 12/31/2015?
Yes_____
No_____
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