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Indiana Full Year Resident Individual Income Tax Return Form

In the case of wanting to report the full year residential income in the State of Indiana to the IRS, the following form has to be completed and submitted.

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Indiana Full-Year Resident 
Individual Income Tax Return  	
2012	
Form
IT-40State Form 154
(R11 / 9-12)	
Due April 15, 2013	  	
If fi ling for a fi scal year, enter the dates (see instructions) (MM/DD/YYYY): 
 from to:	
  	
Spouse’s Social 
Security Number
Place “X” in box if you are 
married fi ling separately. Your Social 
Security Number
Place “X” in box if applying for ITIN Place “X” in box if applying for ITIN
School corporation number (see pages 59 and  60  ) Present address (number and street or rural route)	
 	
Enter below the 2-digit county code numbers (found on the back of Schedule CT-40) for the county where you lived and 
worked on January 1, 2012.
County where 
spouse livedCounty where 
spouse worked County where 
you livedCounty where 
you worked
1.  Enter your federal adjusted gross income (AGI) from your federal tax return (from Form 1040, 
line 37; Form 1040A, line 21; or from Form 1040EZ, line 4) ___________________  Federal AGI 1	
 .00	
2.  Enter amount from Schedule 1, line 8, and enclose Schedule 1  ________  Indiana Add-Backs 2	 .00	
3.  Add line 1 and line 2 ____________________________________________________________   3	 .00	
4.  Enter amount from Schedule 2, line 12, and enclose Schedule 2  _______  Indiana Deductions 4	 .00	
5.  Subtract line 4 from line 3 __________________________________Indiana Adjusted Income 5	 .00	
6.  You must complete Schedule 3. Enter amount from Schedule 3, line 5, 
and enclose Schedule 3   ______________________________________  Indiana Exemptions 6	
 .00	
7.  Subtract line 6 from line 5 _____________________________________State Taxable Income 7	 .00	
8.  State adjusted gross income tax: multiply line 7 by 3.4% (.034)
(if answer is less than zero, leave blank)  ____________________   8	
 .00	
9.  County tax. Enter county tax due from Schedule CT-40
(if answer is less than zero, leave blank)  ____________________   9	
 .00	
10.  Other taxes. Enter amount from Schedule 4, line 4 (enclose sch.)    10	 .00	
11.  Add lines 8, 9 and 10. Enter total here and on line 16 on the back  ___________Indiana Taxes 11	 .00	
Your fi rst name Initial Last name
If fi ling a joint return, spouse’s fi rst name
Initial Last name
City State Zip/Postal code
Foreign country 2-character code (see pg. 6  ) 	
Round all entries	
Suffi x
Suffi x	
	15112 111 6 9 4

12.  Enter credits from Schedule 5, line 8 (enclose schedule) ____ 12	 .00	
13.  Enter offset credits from Schedule 6, line 7 (enclose schedule)  13	 .00	
14.  Automatic Taxpayer Refund credit. 	Leave blank if not eligible.	 See instructions on page 9.	
Enter $ 111  if you are eligible
Enter $ 222  if joint fi ling and both are eligible
Enter $ 111  if joint fi ling but only one is eligible  ___________  14	
 .00	
15.  Add lines 12, 13 and 14  ___________________________________________Indiana Credits 15	 .00	
16.  Enter amount from line 11 ___________________________________________Indiana Taxes 16	 .00	
17.  If line 15 is equal to or more than line 16, subtract line 16 from line 15 (if smaller, skip to line 24)  17	 .00	
18.  Amount from line 17 to be donated to the Indiana Nongame Wildlife Fund ______________   18	 .00	
19.  Subtract line 18 from line 17 _________________________________________Overpayment 19	 .00	
20.  Amount from line 19 to be applied to your 2013 estimated tax account 	(see instructions on page 11 ).	
Enter your county code  county tax to be applied _ $  a	 .00	
Spouse’s county code  county tax to be applied _ $  b	 .00	
Indiana adjusted gross income tax to be applied _________ $  c	 .00	
Total to be applied to your estimated tax account (a + b + c; cannot be more than line 19) _____  20d	 .00	
21.  Penalty for underpayment of estimated tax from Schedule IT-2210 or IT-2210A (enclose sch.)  _   21	 .00	
22. Refund: Line 19 minus lines 20d and 21. Note: If less than zero, see line 24   ___Your Refund 22	 .00	
23. Direct Deposit  (see page  12 )  c. Type:  Checking  Savings  Hoosier Works MC
  a.   Routing Number
  b.   Account Number
  d.  Place an “X” in the box if refund will go to an account outside the United States
24.  If line 16 is more than line 15, subtract line 15 from line 16. Add to this any amount on line 21
(see instructions on page 13 ) ____________________________________________________   24	
 .00	
25. Penalty if fi led after due date (see instructions)  ______________________________________   25	 .00	
26. Interest if fi led after due date (see instructions)  ______________________________________   26	 .00	
27. Amount Due: Add lines 24, 25 and 26 ______________________________Amount You Owe 27	 .00	
Do not send cash. Please make your check or money order payable to: Indiana Department of Revenue. 
Sign and date this return after reading the Authorization statement on Schedule 7. You must enclose Schedule 7.
_____________________________________________________   _________________________________________________
Your Signature  Date  Spouse’s Signature  Date
•  If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, IN  46207-7224. 
•  Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.	
	15112121694
Next: IRS 1040X Amended U.S. Individual Income Tax Return Form Previous: IRS 1065 Schedule K-1 Form
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