IT-65 Form Current Year Partnership Return Forms and Schedules

(a) If Partner Is an Individual (please print clearly) Social Security Number: (b) If Partner Is an Other Entity (please print clearly) Federal Identification Number: (c) Partner s State of Residence or Commercial Domicile c1 (d) Indiana Tax Withheld for Nonresident Partner (on WH 18) d 00 (e) Partner s Federal Pro Rata Percentage e (f) Partner s Tax as Computed on IT 65COMP Column G f 00 (federal Form 7004 or an electronic extension of time)? Y N 1 Ordinary business income (loss) 10 Net IRC Section 1231 gain (loss) 11 Other income (loss) 12 IRC Section 179 expense deduction 13A Portion of expenses related to investment portfolio income 13B Other information from line 20 of federal K 1 related to 14 Carry total on line 14A to Form IT 65 line 1 on front page of 15 Total of Indiana state modifications to distributive share income (see line 2 Form IT 65) 15B 15 C 16 Net other Indiana adjusted gross income distributions from partnerships estates 17 Enter amount of Indiana pass through credits attributed from other partnerships estates and trusts 2 Net rental real estate income (loss) 3 Other net rental income 4 Guaranteed payments 5 Interest Income 6a Ordinary dividends 7 Royalties 8 Net Short term capital gain (loss) 9a Net long term capital gain (loss) a b c 00 A B C D E F G a1 a2 a3 and trusts (add line 14C and 15C) b1 b2 C x 3 4% Cash Accrual Other Check box if amended Check box if name changed City State ZIP Code Continued on next page d e f 00 Distributive Share Amounts: Enter Pro Rata Share Composite Adjusted Gross Income Tax Credits Total Tax expense and other (federal nonitemized) deductions 00 g h i 00 if any including investment interest expense and other (federal investment interest and expenses not listed elsewhere IT 65 2012 Schedule IN K 1 Page 2 Last Name: First Name: Name of Credit: ID Code: Name of Partnership Name of Partnership Federal Identification Number Name: non itemized) deductions not listed elsewhere 00 Number and Street Indiana County or O O S or Other Tax Year Beginning 2012 and Ending partner s distributive share for each allowable credit return Tax Year Beginning 2012 and Ending (Add A + B) (cannot be less than zero) (D + E F) (if applcable) (R11 / 8 12) *12212111594* *13612111594* *13612121594* *24100000000* 1 Ordinary business income (loss) 00 1 Total net income (loss) from U S partnership return Form 1065 Schedule K lines 1 through 11 less line 12 and a portion of line 13 10 Net IRC Section 1231 gain (loss) 00 10 Subtotal (line 7 minus lines 8 and 9) If total is greater than zero proceed to lines 11 12 and 13 10 00 11 Interest: Enter total interest due; see instructions (contact the Department for current interest rate) 11 00 11 Other income (loss) 00 12 IRC Section 179 expense deduction 00 12 Penalty: If paying late enter 10% of line 10 If line 7 is zero enter $10 per day filed past the due date; see instructions 12 00 12212111594 13 Penalty: If failing to include all nonresident partners on composite return enter $500; see instructions 13 00 13 Subtotals for columns D E F and G 13612111594 13612121594 13a Portion of expenses related to investment portfolio income including investment interest 13b Other information from line 20 of federal K 1 related to investment interest and expenses 14 Carryover totals from additional sheets 14 Total Amount Due (add lines 10 through 13) If less than zero enter on line 15 Make payment in U S funds 14 00 14 Total pro rata distributions (Add lines 1 through 11; subtract lines 12 13a and 13b when applicable ) 00 14A 14B 14 C 15 Overpayment (line 8 plus line 9 minus lines 7 11 12 and 13) 15 00 15 State income taxes deducted 00 15 Total tax (13G + 14G) 16 Net bonus depreciation allowance 00 16 Refund: Amount from line 15 No carryforward allowed Enter as a positive figure 16 00 17 Excess IRC Section 179 deduction 00 18 Interest on U S obligations 00 19 Addback/ Deduction Code: 00 2 Net rental real estate income (loss) 00 20 Addback/ Deduction Code: 00 21 Addback/ Deduction Code: 00 22 Addback/ Deduction Code: 00 23 Addback/ Deduction Code: 00 24 Addback/ Deduction Code: 00 24100000000 25 Addback/ Deduction Code: 00 26 Addback/ Deduction Code: 00 27 Total distributive share of modifications (add lines 15 through 26 and carry total to Column B 28 Enter the name of the tax credit program its three digit ID code and the dollar amount of the 29 Total pass through credits (add lines 28c 28f and 28i) 00 2a Enter name of addback or deduction (see instructions) Code No 2a 00 2b Enter name of addback or deduction Code No 2b 00 2c Enter name of addback or deduction Code No 2c 00 2d Enter name of addback or deduction Code No 2d 00 2e Enter name of addback or deduction Code No 2e 00 2f Enter the total amount of addbacks and deductions from any additional sheets (use a minus sign for negative amount) 2f 00 3 Other net rental income (loss) 00 3 Total partnership income as adjusted (add lines 1 through 2f) 3 00 4 Enter percentage for Indiana apportioned adjusted gross income from IT 65 Schedule E line 9 if applicable 4 4 Guaranteed payments 00 5 Interest income 00 5 Sales/use tax due on purchases subject to use tax from Sales/Use Tax worksheet (from page 20) 5 00 6 Ordinary dividends 00 6 Total composite tax from completed Schedule IT 65COMP (15G) Attach schedule 6 00 7 Royalties 00 7 Total tax (add lines 5 and 6) Caution: If line 7 is zero see line 12 late file penalty 7 00 8 Net short term capital gain (loss) 00 8 Total amount of withholding (attach WH 18 statement(s) for composite members) 8 00 9 Net long term capital gain (loss) 00 9 Other payments/credits belonging to the partnership (attach documentation) 9 00 Address Adjusted gross Aggregate Partnership Distributive Share Income (see worksheet) All Sources amounts for lines 1 through 26 of any nonresident partner must be multiplied by the Indiana apportionment Apportioned Attach WH 18 copy C for each nonresident composite partner attributed to Carry total tax and credits from line 15G to Summary of Calculations Enter total tax on Form IT 65 line 6 Certification of Signatures and Authorization Section County tax Distributions Attributed to Indiana Distributions from Distributions Provide IN K 1 to each partner Enclose IN K 1 with IT 65 return For information on the acceptable electronic data file format visit the Department s website at www in gov/dor/3772 htm Pro rata distributive income Enter for line 14B below total distributive share income received by the partnership from all other non unitary partnerships estates and trusts Enter for line 15B an amount equal to required state modifications for Indiana Adjusted Gross Income (see page 8 instructions) Enter for line 14C below total distributive share income received by the partnership from other partnerships estates and trusts that were derived from or allocated to Indiana Enter for line 15C an amount equal to the Indiana modifications to adjusted gross income attributed to Indiana Enter part ner's tax liability Enter pro rata credits from IN K 1 line 29 (may not exceed D) Enter the partner s pro rata amounts as determined by the partnership entity s completed IT 65 Apportionment Schedule E Duplicate this worksheet for each corporate partner (These amounts are to be included with the corporate partner s own apportionment factor ) Estates/Trusts Everywhere Federal Identification Number for Calendar Year Ending December 31 2012 Form IT 65 Form IT 65 For nonresidents apply apportioned figures (Use a minus sign to denote I authorize the Department to discuss my return with my personal If a corporate partner and a partnership maintain a unitary business relationship as described above the partnership distribution shall be distributed to the partner without any apportionment by the partnership If the partner derives income from sources both within and outside Indiana and is required to apportion its income the partner s apportionment factor shall include the partner s proportionate share of the apportionment factor of the partnership If you do not owe any tax mail it to IN Department of Revenue PO Box 7147 Indianapolis IN 46207 7147 If you owe tax please mail your return to IN Department of Revenue PO Box 7205 Indianapolis IN 46207 7205 income Indiana Department of Revenue Indiana Department of Revenue Indiana from IN K 1 line 14 Indiana modifica tions from IN K 1 line 27 Indiana Partnership Return IT 65 2012 Schedule IN K 1 IT 65 Apportionment Receipts Factors K Date of organization In the State of L State of commercial domicile Less allowable deductions for state tax purposes: List name distributive amount composite tax and credits for each composite return member Omit cents M Year of initial Indiana return multiply C by N Accounting method: Name of Partnership Federal Identification Number negative amounts ) nonresident county tax rate O Check all boxes that apply to entity: Initial Return Final Return In Bankruptcy Composite Return on Schedule IT 65COMP) 00 P Enter total number of partners: Enter number of nonresident partners: Paid Preparer s Signature Date Paid Preparer: Firm s Name (or yours if self employed) Part 1 Partner s Identification Section Part 2 Distributive Share Amount (use apportioned figures for nonresident partners) Part 3 State Modifications Add or subtract the following Designate the distributive share amount of each modification for Indiana adjusted gross income from line 2 on the front of Part 4 Pro Rata Share of Indiana Pass through Tax Credits from Partnership Partner s Share of Indiana Adjusted Gross Income Deductions Modifications and Credits Partners Composite Indiana Adjusted Gross Income Tax Return Partnership Partnership s Tax Year 2012 or Other Year Beginning 2012 and Ending Partnership's Distributive Share of Items Partnership's E mail Address EE Partnerships/ percent if applicable from IT 65 line 4 Personal Representative s Name (Print or Type) Principal Business Activity Code Print or Type Name of Corporate Officer Title Q Do you have on file a valid extension of time to file your return R Are you a limited liability company electing partnership treatment on your federal return? Y N related to investment income (see instructions); use minus sign for negative amounts 1 00 representative (see page 12) Y N Round all entries S Is this partnership a member of any other partnership(s)? Y N Schedule E: Schedule IT 65COMP See instructions on page 22 Enclose with Form IT 65 (use additional sheets if necessary) Signature of Corporate Officer Date State Form 11800 (R11 / 8 12) State Form 49180 State Form 49181 (R12 / 8 12) State tax multiply State Zip Code + 4 Summary of Calculations Telephone Number Telephone Number Total from All States Line 1B Total from Indiana Sources Line 1A 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 Use the following table to show apportionment factor s values from the partnership assigned to the unitary corporate partner Partnerships deriving income from sources both within and outside Indiana or having any corporate partners must complete the IT 65 Apportionment Schedule E Use the worksheet whenever partnership income is being distributed to a corporate partner having a unitary relationship with the partnership A unitary business relationship means maintaining business activities or operations that are of mutual benefit dependent upon or contributory to one another in transacting business between a corporate partner and the partnership Unity may be established whenever there is unity of operation and use evidenced by centralized management or executive force centralized purchasing advertising accounting or other controlled interaction between a corporate partner and the partnership Use this worksheet to compute the entry for line 1 of Form IT 65 and to assist in computing amounts reported on IT 65 Schedule IN K 1 Enter the total distributive share of income from each item as reportable on Form 1065 Schedule K Do not complete Column B and C entry lines unless the partnership received distributive share or tiered income from other entities Worksheet for Attributing Partnership Income for Unitary Corporate Partners Worksheet for Partnership Distributive Share Income Deductions and Credits