IT-41 Schedule IN K-1 — Beneficiary's Share of Indiana AGI

# preamble

Beneficiary's Share of Indiana Adjusted Gross Income, Deductions, Modifications, and Credits T ax Year Beginning and Ending 11. Pass Through Entity Tax_________________________________________________________ 11 .00 12. Indiana State Tax Withheld _______________________________________________________ 12 .00 13. Indiana County Tax Withheld _____________________________________________________ 13 .00

# Part 2 - Pro Rata Share of Indiana Pass-through Tax Credits from Trust or Estate

Column A IT-41 Federal ID Number if Credit is from I N K-1 Column B Certification Year Column C Certification/Project/PIN Number Column D Tax Credit Code Column E Amount Claimed 1. .00 2. .00 3. .00 4. .00 5. .00 Name of Trust or Estate IT-41 2025 Schedule I N K-1 Federal Employer Identification Number

# Part 1 - Identification and Distribution Information

Provide a copy of this Schedule I N K-1 reflecting the beneficiary's share of income, deductions, and credits to each beneficiary. Enclose a copy of each Schedule I N K-1 with the Form IT-41 return when filing. 1. Beneficiary's Name Amended I N K-1 2. Beneficiary's F E I N or Social Security Number 7. Beneficiary's Federal Pro Rata Percentage 9. Payer's Name 10. Payer's F E I N Final I N K-1 Nonresident Beneficiary 3. Beneficiary's Address 4. Beneficiary's City 5. Beneficiary's State 6. Beneficiary's ZIP Code 8. Indiana County of Principal Employment 2-digit code Trusts and Estates with more than 9 I N K-1s must file electronically %.

Part 3 - Distributive Share Amount (use the Indiana apportioned figures for the beneficiary) 1. Interest income ________________________________________________________________ 1 .00 2. Ordinary dividends _____________________________________________________________ 2 .00 3. Net short-term capital gains _____________________________________________________ 3 .00 4. Net long-term capital gains _______________________________________________________ 4 .00 5. Other portfolio and nonbusiness income ____________________________________________ 5 .00 6. Ordinary business income _______________________________________________________ 6 .00 7. Net rental real estate income _____________________________________________________ 7 .00 8. Other rental income ____________________________________________________________ 8 .00 9. Directly apportioned deductions ___________________________________________________ 9 .00 10. Final year deductions ___________________________________________________________ 10 .00 11. Total pro rata distributions (If lines 1 through 8 are positive, add them. If lines 1 through 8 are negative, see instructions. Also see instructions for reporting lines 9 and 10.) ____________ 11 .00 Part 4 - State Modifications Add or subtract the following. Enter the distributive share amount of each modification for Indiana adjusted gross income. For nonresidents, apply apportioned figures. (Use a minus sign to denote negative amounts.) 1. State income taxes deducted _____________________________________________________ 1 .00 2. Net bonus depreciation allowance _________________________________________________ 2 .00 3. Excess I R C Section 179 deduction ________________________________________________ 3 .00 4. Interest on U.S. obligations ______________________________________________________ 4 .00 5. Add-back/Deduction __________________________________________ Code # 5 .00 6. Add-back/Deduction __________________________________________ Code # 6 .00 7. Add-back/Deduction __________________________________________ Code # 7 .00 8. Total distributive share of modifications (see instructions) ______________________________ 8 .00 9. Add Part 3, line 11, to Part 4, line 8. See instructions for reporting on Schedule PTET, Schedule Composite, and/or Schedule Composite-COR ___________ Adjusted Gross Income 9 .00