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Schedule H Section 1: Residency Information Schedule H Form IT-40PNR (Complete Section 2: Additional Information on back) State Form 54035 (R5 / 9-14) Name(s) shown on Form IT-40PNR Section 1: Residency
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2014 Indiana Illinois YesNo IT-40PNR XNo Preparer 2014Yes 2C 2B 07A IT-9 PTIN IT-2210 ePay 2A Preparers 2D 1A 1D 1B R5 1C 2-letter jointly Enclosure opt OC thirds spouses routing electronically payable

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