Read Instructions First 1. Enter gross income from your Indiana employment _ _____________ 1A 00 1B 00 2. Allowable deductions: attach federal Schedule 1_________________ 2A 00 2B 00 3. Indiana adjusted gross income: line 1 minus line 2_ ______________ 3A 00 3B 00 4. County tax rate from chart (see instructions)____________________ 4A 4B 5. County tax due: multiply line 3 x line 4 _________________________ 5A 00 5B 00 6. Total county tax due: add lines 5A and 5B_______________________________________ Total Tax 6 00 7. Indiana state tax withheld: See Instructions ______________________________________________ 7 00 8. Indiana county tax withheld: See Instructions_____________________________________________ 8 00 9. Add lines 7 and 8 _______________________________________________________ Total Credits 9 00 10. Overpayment: if line 9 is more than line 6, subtract line 6 from line 9 and enter amount to be refunded to you______________________________________________ Your Refund 10 00 11. a. Routing Number c. Type: Checking Savings b. Account Number d. Place an “X” in the box if refund will go to an account outside the United States. 12. Subtract line 9 from line 6 if line 6 is greater than line 9_____________________________________ 12 00 13. Penalty if filed after the due date (see instructions)________________________________________ 13 00 14. Interest if filed after the due date (see instructions)________________________________________ 14 00 15. Total amount you owe: add lines 12, 13 and 14____________________________ Amount You Owe 15 00 Do not send cash. Please make your check or money order payable to: Indiana Department of Revenue. See instructions if paying by credit card or electronic check. Indiana Department of Revenue Reciprocal Nonresident Indiana Individual Income Tax Return Due April 15, 2026 Form IT-40RNR State Form 44406 (R24 / 9-25) Enter the 2-digit code numbers (see instructions) for the county and/or state where you lived and worked on Jan. 1, 2025. Your State of Residence Place "X" in the appropriate box to indicate your state of residence for 2025. Kentucky Michigan Ohio Pennsylvania Wisconsin Note. You must file Form IT-40PNR, Part-Year Resident or Nonresident Indiana Individual Income Tax Return, if you were a resident of a state other than those listed; had Indiana income other than wages, salaries, tips or commissions; or were a part-year resident of Indiana during 2025. Important: You must file Form IT-40PNR if you have Indiana riverboat winnings. Place "X" in box if amending. Column A – Yours Column B – Spouse’s If any individual listed above died during 2025, enter date of death below (MM/DD). Taxpayer’s date of death 2025 Spouse’s date of death 2025 2025 Spouse’s Social Security Number Your Social Security Number Place “X” in box if you are married filing separately. Present address (number and street or rural route) City State ZIP/Postal code Foreign country 2-character code Your first name Initial Initial Last name Last name If filing a joint return, spouse’s first name Suffix Suffix . . Direct Deposit (see instructions) State where you lived County where you worked State where spouse lived County where spouse worked *16025111694* 16025111694

Additional Required Information Enter the number of days you worked in Indiana during this calendar year (see instructions). You Spouse Extension of Time to File Place "X" in box if you have filed a federal extension of time to file, Form 4868, or made an online extension payment. Place "X" in box if you have filed an Indiana extension of time to file, Form IT-9, or made an Indiana extension payment online. Authorization Under penalty of perjury, I have examined this return and all attachments and to the best of my knowledge and belief, it is true, complete and correct. I understand that if this is a joint return, any refund will be made payable to us jointly and each of us is liable for all taxes due under this return. Also, my request for direct deposit of my refund includes my authorization to the Indiana Department of Revenue (DOR) to furnish my financial institution with my routing number, account number, account type and Social Security number to ensure my refund is properly deposited. I grant permission to DOR to contact the Social Security Administration to confirm that the Social Security number(s) used on this return is correct. Your Signature___________________________________ Date_ _____________ Spouse’s Signature_______________________________ Date_ _____________ Daytime telephone number Email address where we can reach you • If enclosing payment mail to: Indiana Department of Revenue, P.O. Box 7224, Indianapolis, I N 46207-7224. • Mail all other returns to: Indiana Department of Revenue, P.O. Box 40, Indianapolis, I N 46206-0040. I authorize the Department to discuss my return with my personal representative. Yes No If yes, complete the information below. Personal Representative’s Name (please print) Telephone number Address City State ZIP Code Paid Preparer: Firm’s Name (or yours if self-employed) I N-O P T on file with paid preparer if not filing electronically PT IN Address City State ZIP Code Preparer’s signature *16025121694* 16025121694

Personal Representative Information Typically, DOR will contact you (and your spouse, if filing jointly) if there are any questions or concerns about your tax return. If you want DOR to be able to discuss your tax return with someone else (e.g. the person who prepared it, a relative or friend, etc.), you’ll need to complete this area. If you complete this area, you are authorizing DOR to be in contact with someone other than you concerning information about this tax return. You may decide at any time to revoke the authorization for DOR to be in contact with your personal representative. If you do, you must provide a signed statement to DOR. Include your name, Social Security number and the year of your tax return. Mail your statement to Indiana Department of Revenue, P.O. Box 40, Indianapolis, I N 46206-0040. Paid Preparer Information Fill out this area if a paid preparer completed this tax return. Who may file Form IT-40RNR? Full-year residents of Kentucky, Michigan, Ohio, Pennsylvania, or Wisconsin may use this form if: • Your income from Indiana sources is only from wages, salaries, tips or commissions, and • Your Indiana credits are only from Indiana state and/or county taxes withheld. While unemployment compensation from Indiana sources received by an Indiana nonresident is not subject to tax in Indiana, you must file Form IT-40PNR to claim a refund of ANY Indiana state/county withholdings. Professional team members cannot file Form IT-40RNR; they must file Form IT-40PNR. Important. Do not file this form if you have Indiana riverboat winnings. You must file Form IT-40PNR. Form IT-40RNR allows you to figure county tax due. You may owe county tax if, on Jan. 1, 2025, you worked in an Indiana county. Carefully read the instructions for lines 1 through 5 to figure any county tax due. Important. Complete your federal tax return first. If you file a joint federal return, you must file a joint Indiana return. If you file a separate federal return, you must file a separate Indiana return. County Information Section Since you were a full-year nonresident of Indiana for 2025, you must enter the 2-digit code number for the state in which you lived. You'll find this number on the chart on page 1 of the instructions. The county where you worked will be that county where you performed the principal amount of your work on Jan. 1, 2025. Changes in the Indiana county where you worked after Jan. 1, 2025, will not affect your county tax liability until the following year. If you did not work in Indiana until after Jan. 1, 2025 (or not at all), you are not subject to county tax this year. You should enter your 2-digit state code number in the County where you worked boxes. Answer the following questions: • Was your principal place of employment on Jan. 1, 2025, located in an Indiana county? If yes, move to the next question. If no, skip lines 1 through 6 and enter all Indiana state and county withholding amounts on lines 7 and/or 8. • If you answered yes to the above question, complete all appropriate lines, beginning with line 1. If no, skip lines 1 through 6 and enter any Indiana withholding amounts on lines 7 and/or 8. Line-by-Line Instructions Lines 1A and 1B – Gross income from Indiana principal place of employment (county where you worked). Enter the amount of wages, tips, salaries, and commissions earned in Indiana. If you received any other type of income from Indiana, such as partnership, farm, sole proprietorship, etc., then do not file this form. Instead, Form IT-40PNR must be filed. Note. If you worked for 30 days or less in Indiana during 2025, you may be eligible to claim an exemption for wages earned during 2025. If you are eligible for the exemption, do not include your wages earned in Indiana during 2025. See Income Tax Information Bulletins 28, 32, and 33 for further information. Lines 2A and 2B – Allowable deductions. Enter any deduction claimed on your federal return (Form 1040/1040- SR, Schedule 1, Part 2) that applies directly to your Indiana earned income. Such a deduction could include the educator expense, if it is directly related to the income reported on line 1. Note. Exemptions are not allowed when figuring income subject to county tax on Form IT-40RNR (see 45 IAC 3.1-4-4(g) of the Indiana Administrative Code available at iac.iga.in.gov/iac). Line 3 – Indiana Adjusted Gross Income. Subtract line 1 from line 2. If the answer is less than zero, leave blank. Line 4A and 4B – County tax. Enter the county tax rate from the chart for the county where you worked on Jan. 1, 2025. Line 7 – Indiana State Tax Withheld. Enter Indiana state tax withheld from Line 26, Column E of Schedule I N-W. You must enclose Schedule I N-W and your W-2(s). Line 8 – Indiana County Tax Withheld. Enter Indiana county tax withheld from Line 27, Column G of Schedule I N-W. You must enclose Schedule I N-W and your W-2(s). Instructions for IT-40RNR, Reciprocal Nonresident Indiana Individual Income Tax Return

Line 11 – Direct Deposit. If you want your refund directed into your bank account, complete lines 11a, b and c. a. The routing number is 9 (nine) digits, with the first two digits of the number beginning with 01 through 12 or 21 through 32. b. The account number can be up to 17 digits. Omit any hyphens, accents and special symbols. c. Check the appropriate box for the type of account you are making your deposit. d. To comply with banking rules, you must place an X in the box on line d if your refund is going to an account outside the United States. If you check the box, we will mail you a paper check. Line 13 – Penalty. If your return is filed after the April 15, 2026 due date, and you have an amount due, you will probably owe a penalty. Penalty is 10% of the line 12 amount due or $5, whichever is greater. Exception: If you have a valid federal or state extension of time to file, are filing by the extended filing due date, and have prepaid at least 90% of the tax expected to be due, then no penalty will be due. Line 14 – Interest. If your tax return is filed after the April 15, 2026, due date and you have an amount due on line 12, you will owe interest (even if you have a filing extension). See Departmental Notice #3 at www.in.gov/dor/files/dn03.pdf for the current interest rate. Line 15 – Amount You Owe. There are several ways to pay the amount you owe. If paying by mail, make checks, money orders or cashier's checks payable to: Indiana Department of Revenue. Note. All payments made to the Indiana Department of Revenue must be made with U.S. funds. Accepted forms of payment via INTIME include bank payment (ACH/e-check), as well as Visa, MasterCard and Discover debit or credit cards. Processing fee(s) will be assessed for debit or credit card payments. There is no fee for bank (ACH/e-check) payments. The INTIME User Guide for Individual Income Tax Customers, available at www.in.gov/dor/ files/intime-individual-guide.pdf, will guide you through the process of making a payment. Payment plan option. If you cannot pay the full amount due at the time you file, you may be eligible to set up a payment plan online. Log on to INTIME at intime.dor.in.gov and select the Payments tab once you receive a tax bill in the mail. Filing an Amended (Corrected) Tax Return. If you need to amend (correct) your 2025 individual income tax return after you initially filed: • Prepare another IT-40RNR return that reflects all changes and check the “Amended” box on the front page. Failure to do so can delay processing. • Attach a copy of all required schedules reflecting all changes and documentation. Failure to do so can delay processing. • File the amended return electronically, if possible. Note. Any refund previously received should not be reported on an amended filing. You will be issued a notice for repayment of any previous refunds. Additional Required Information. Enter the number of days you worked in Indiana during 2025. In addition, if you are filing a joint return with your spouse, also enter the number of days your spouse worked in Indiana. Include the days from all places of employment in Indiana. See Income Tax Bulletins 28, 32, and 33 for further information. CAUTION: a blank entry in a box will be treated as if you and/ or your spouse worked the full calendar year in Indiana.

2025 Indiana County Income Tax Rates and County Codes *These rates have changed from last year’s chart. (R24 / 9-25) County Code # County Name County Tax Rate 01 Adams .016 02 Allen .0159 03 Bartholomew .0175 04 Benton .0179 05 Blackford .025 06 Boone .017 07 Brown .025234 08 Carroll .022733 09 Cass .0295 10 Clark .02 11 Clay .0235 12 Clinton .0265 13 Crawford .0165 14 Daviess .015 15 Dearborn .014 16 Decatur .0245* 17 DeKalb .0213 18 Delaware .015 19 Dubois .012 20 Elkhart .02 21 Fayette .0282* 22 Floyd .0189* 23 Fountain .021 24 Franklin .017 25 Fulton .0288* 26 Gibson .013* 27 Grant .0255 28 Greene .0215 29 Hamilton .011 30 Hancock .0194 31 Harrison .01 32 Hendricks .017 33 Henry .0202* 34 Howard .0195 35 Huntington .0195 36 Jackson .021 37 Jasper .02864 38 Jay .025* 39 Jefferson .0103 40 Jennings .025 41 Johnson .014 42 Knox .017 43 Kosciusko .01 44 LaGrange .0165 45 Lake .015 46 LaPorte .0145 47 Lawrence .0175 48 Madison .0225 49 Marion .0202 50 Marshall .0125 County Code # County Name County Tax Rate 51 Martin .025 52 Miami .0254 53 Monroe .0214* 54 Montgomery .0265 55 Morgan .0272 56 Newton .01 57 Noble .0175 58 Ohio .02 59 Orange .0175 60 Owen .025 61 Parke .0265 62 Perry .014 63 Pike .012 64 Porter .005 65 Posey .0145 66 Pulaski .0285 67 Putnam .023 68 Randolph .03 69 Ripley .0238 70 Rush .0215* 71 St. joseph .0175 72 Scott .0216 73 Shelby .016 74 Spencer .008 75 Starke .0171 76 Steuben .0199 77 Sullivan .017 78 Switzerland .0145* 79 Tippecanoe .0128 80 Tipton .026 81 Union .02 82 Vanderburgh .0125 83 Vermillion .015 84 Vigo .02 85 Wabash .029 86 Warren .0212 87 Warrick .01 88 Washington .02 89 Wayne .0125 90 Wells .021 91 White .0232 92 Whitley .016829 State Code Certain States State Code Certain States 94 Illinois 98 Pennsylvania 95 Kentucky 99 Wisconsin 96 Michigan 00 All Other States 97 Ohio *24100000000* 24100000000