Form Ct-1040x - Amended Connecticut Income Tax Return For Individuals - 2001
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2STATE OF CONNECTICUT
FORM CT-1040
DEPARTMENT OF REVENUE SERVICES
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Connecticut Resident Income Tax Return
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For the year January 1 - December 31, 2001, or other taxable year
beginning ___________ , 2001,
ending _________________ , _______ .
Social Security Number
Label
Your First Name and Middle Initial
Last Name
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A
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Use the
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DRS label
Spouse’s Social Security Number
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
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located on
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cover.
IMPORTANT!
Home Address (number and street), Apartment Number, PO Box
Otherwise,
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You MUST enter your SSN(s) above.
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print or
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type. (See
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City, Town, or Post Office
State
ZIP Code
DEPARTMENT USE ONLY
instructions,
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–
– 20
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Page 12)
WEBFILING OR ELECTRONIC FILING MAY SPEED YOUR REFUND, see Page 5.
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Check here if you do not want forms sent to you next year. Checking this box does not relieve you of your responsibility to file .........
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If you are required to file Form CT-2210 and checked any boxes on Part 1 of that form, check here ................................................
NOTE: Generally, your filing status must be the same as your federal income tax filing status for this year (See instructions, Page 12) .
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Filing
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Single
A.
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Status
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B.
Married filing joint return or Qualifying widow(er) with dependent child
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Check only
Married filing SEPARATE return
C.
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Spouse’s full name
Spouse’s Social Security Number
one box.
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D.
Head of household (with qualifying person)
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1. Federal Adjusted Gross Income (from federal Form 1040, Line 33; Form 1040A, Line 19;
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Form 1040EZ, Line 4; or federal Telefile Tax Record, Line
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)
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2. Additions, if any (from Schedule 1 , Line 37, on reverse)
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Income
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3. Add Line 1 and Line 2
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4. Subtractions, if any (from Schedule 1 , Line 47, on reverse)
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5. Connecticut Adjusted Gross Income (Subtract Line 4 from Line 3)
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6. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, Page 12)
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7. Credit for income taxes paid to qualifying jurisdictions (from Schedule 2 , Line 56 on reverse)
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8. Subtract Line 7 from Line 6. (If Line 7 is greater than Line 6, enter “0.”)
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9. Connecticut Alternative Minimum Tax (from Form CT-6251)
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10. Add Line 8 and Line 9
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11. Credit for property taxes paid on your primary residence and/or motor vehicle (You must complete
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Schedule 3 , on reverse and enter the amount from Line 64 here. See instructions, Page 13. )
Tax
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12. Subtract Line 11 from Line 10 (If less than zero, enter “0.”)
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13. Adjusted Net Connecticut Minimum Tax Credit (from Form CT-8801)
14. Connecticut Income Tax (Subtract Line 13 from Line 12. If less than zero, enter “0.”)
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15. Individual Use Tax (Complete the Individual Use Tax Worksheet.) You must enter zero on
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this line if no use tax is due. (See instructions, Page 13)
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16. Total Tax (Add Line 14 and Line 15)
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17. Connecticut tax withheld (Attach all W-2s and certain 1099s; see instructions, Page 13 )
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18. All 2001 estimated tax payments and any overpayments applied from a prior year
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Payments
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19. Payments made with Form CT-1040 EXT (request for extension of time to file)
20. Total Payments (Add Lines 17, 18, and 19)
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21. If Line 20 is greater than Line 16, enter amount overpaid. (Subtract Line 16 from Line 20)
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22. Amount of Line 21 you want applied to your 2002 estimated tax
23. Amount of Line 21 you want to contribute to: ( See instructions, Page 13 )
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AIDS Research
___ $2
____ $5
___ $15
other _______ .00
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Organ Transplant
___ $2
____ $5
___ $15
other _______ .00
R e f u n d
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Endangered Species/Wildlife
___ $2
____ $5
___ $15
other _______ .00
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Breast Cancer Research
___ $2
____ $5
___ $15
other _______ .00
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Safety Net Services
___ $2
____ $5
___ $15
other _______ .00
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Total Contributions
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24. Amount of Line 21 you want refunded to you. (Subtract Line 22 and Line 23 from Line 21)
REFUND
25. If Line 16 is greater than Line 20, enter the amount of tax you owe. (Subtract Line 20 from Line 16) u 25
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26. If Late: Enter Penalty (Multiply Line 25 by 10% (.10))
Amount
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27. If Late: Enter Interest (Multiply Line 25 by number of months late or fraction thereof, then by 1% (.01))
You Owe
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28. Interest on underpayment of estimated tax (from Form CT-2210; see instructions, Page 14 )
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29. Amount you owe with this return (Add Lines 25 through 28)
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AMOUNT YOU OWE
(See instructions, Page 14)
Check if paying by credit card
Use envelope provided, with correct mailing label, or mail to:
Make your check or money order payable to:
Commissioner of Revenue Services
For refunds and all other tax forms without payment –
For all tax forms with payment–
Department of Revenue Services
Department of Revenue Services
Write your Social Security Number(s) and
PO Box 2976
PO Box 2977
“2001 Form CT-1040” on your check or
Hartford CT 06104-2976
Hartford CT 06104-2977
money order.
Taxpayers must sign declaration on reverse — Due date: April 15, 2002 — Attach a copy of all applicable schedules and forms to this return.
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