Form Ct-1040 - Connecticut Resident Income Tax Return - 2002 Page 2
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1
2Schedule 1 Modifications To Federal Adjusted Gross Income ( enter all amounts as positive numbers )
30. Interest on state and local government obligations other than Connecticut
30
31. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government obligations
31
Additions
32. Special depreciation allowance for qualified property
32
to Federal
Adjusted
33. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted gross income
33
Gross
34. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if greater than zero)
34
Income (See
instructions,
35. Loss on sale of Connecticut state and local government bonds
35
Page 18)
36. Other - specify __________________________________________________________________________
36
37. TOTAL ADDITIONS (Add Lines 30 through 36) Enter here and on Line 2.
37
38. Interest on U.S. government obligations
38
39. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations
39
40. Social Security benefit adjustment (See Social Security Benefit Adjustment Worksheet, Page 20)
40
Subtractions
41. Refunds of state and local income taxes
41
from Federal
Adjusted
42. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities
42
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
Gross
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
43. Do not use. Line reserved for future use
43
Income (See
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
instructions,
44. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if less than zero)
44
Page 19)
45. Gain on sale of Connecticut state and local government bonds
45
46. Other - specify (Do not include out-of-state income) ___________________________________________
46
47. TOTAL SUBTRACTIONS (Add Lines 38 through 46) Enter here and on Line 4.
47
Schedule 2 Credit for Income Taxes Paid to Qualifying Jurisdictions
48. MODIFIED CONNECTICUT ADJUSTED GROSS INCOME (See instructions, Page 24)
48
Important:
COLUMN A
COLUMN B
You must
FOR EACH COLUMN, ENTER THE FOLLOWING:
Name
Code
Name
Code
attach a
49. Enter qualifying jurisdiction’s name and two-letter code (See instructions, Page 24) 49
copy of your
return filed
50. Non-Connecticut income included on Line 48 and reported on a qualifying
with the
jurisdiction’s income tax return (Complete Schedule 2 Worksheet, Page 23 )
50
.
.
qualifying
51. Divide Line 50 by Line 48 (May not exceed 1.0000)
51
.
jurisdiction(s)
or your
52. Income tax liability (Subtract Line 11 from Line 6 )
52
credit
53. Multiply Line 51 by Line 52
53
will be
disallowed.
54. Income tax paid to a qualifying jurisdiction (See instructions, Page 25)
54
55. Enter the lesser of Line 53 or Line 54
55
56. TOTAL CREDIT (Add Line 55, all columns) Enter here and on Line 7.
56
Schedule 3
Credit for Property Taxes Paid on Your Primary Residence and/or Motor Vehicle
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
QUALIFYING
Name of
List or Bill
Date(s) Paid
Description of Property
(See instructions,
Amount Paid
PROPERTY
Connecticut Tax
If primary residence, enter street address
N u m b e r
Page 26)
If motor vehicle, enter year, make, and model
Town or District
(If available)
PRIMARY
57
RESIDENCE
AUTO 1
58
MARRIED FILING
59
JOINTLY ONLY - AUTO 2
60. TOTAL PROPERTY TAX PAID (Add all amounts for Column E)
60
Property
500 00
61. MAXIMUM PROPERTY TAX CREDIT ALLOWED
61
Tax
62. Enter the Lesser of Line 60 or Line 61. (If $100 or less, enter amount on Line 64. If greater than $100, go to Line 63.)
62
Credit
Calculation
63. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet (See Page 27)
63
64. Subtract Line 63 from Line 62. Enter here and on Line 11.
64
Schedule 4 Contributions of Refund to Designated Charities (See instructions, Page 28)
AIDS Research
___ $2
__ $5
_ $15
other ___ .00
Breast Cancer Research
___ $2
__ $5
_ $15
other ___ .00
Organ Transplant
___ $2
__ $5
_ $15
other ___ .00
Safety Net Services
___ $2
__ $5
_ $15
other ___ .00
Endangered Species/Wildlife
___ $2
__ $5
_ $15
other ___ .00
00
65. TOTAL CONTRIBUTIONS. Enter here and on Line 23.
65
Third
Do you authorize DRS to contact another person about this return? ( See Page 17 )
Yes. Complete the following.
No
Party
Designee’s Name
Telephone Number
Personal Identification
Designee
(
)
Number (PIN)
I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and belief,
it is true, complete, and correct. I understand that the penalty for willfully delivering a false return to DRS is a fine of not more than $5,000, or imprisonment for not
more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Sign Here
Your Signature
Date
Daytime Telephone Number
(
)
Keep a
Spouse’s Signature (if joint return)
Date
Daytime Telephone Number
copy for
(
)
your
records.
Paid Preparer’s Signature
Date
Telephone Number
Preparer’s SSN or PTIN
(
)
Firm’s Name, Address, and ZIP Code
FEIN
Form CT-1040 Back (Rev. 12/02)
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