Form Ct-1040x - Amended Connecticut Income Tax Return For Individuals

SCHEDULE 1 MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME ( Enter all amounts as positive numbers )

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30. Interest on state and local government obligations other than Connecticut

31. Exempt-interest dividends from a mutual fund derived from state or municipal government obligations

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other than Connecticut

Additions to

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32. Shareholder’s pro rata share of S corporation nonseparately computed loss (See instructions, Page 15)

Federal

Adjusted

33. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted gross income u 33

Gross Income

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34. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if greater than zero)

(See instructions,

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35. Loss on sale of Connecticut state and local government bonds

Page 15)

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36. Other - specify _____________________________________________________

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37. TOTAL ADDITIONS (Add Lines 30 through 36) Enter here and on Line 2 on the front of this form.

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38. Interest on United States government obligations

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39. Exempt dividends from certain qualifying mutual funds derived from United States government obligations

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40. Social Security benefit adjustment (See Social Security Benefit Adjustment Worksheet, Page 17)

Subtractions

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41. Refunds of state and local income taxes

From Federal

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42. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities

Adjusted

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43. Shareholder’s pro rata share of S corporation nonseparately computed income (See instructions, Page 17)

Gross Income

(See instructions,

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44. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if less than zero)

Page 16)

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45. Gain on sale of Connecticut state and local government bonds

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46. Other - specify (Do not include out-of-state income) __________________________________________

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47. TOTAL SUBTRACTIONS (Add Lines 38 through 46) Enter here and on Line 4 on the front of this form.

SCHEDULE 2

CREDIT FOR INCOME TAXES PAID TO QUALIFYING JURISDICTIONS

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48. MODIFIED CONNECTICUT ADJUSTED GROSS INCOME (See instructions, Page 21)

COLUMN A

COLUMN B

FOR EACH COLUMN, ENTER THE FOLLOWING:

Name

Code

Name

Code

Important:

You must

49. Enter qualifying jurisdiction’s name and two-letter code (See instructions, Page 21) 49

attach a copy

50. Non-Connecticut income included on Line 48 and reported on a qualifying

jurisdiction’s income tax return (Complete Schedule 2 Worksheet, Page 20 ) u 50

of your return

filed with the

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51. Divide Line 50 by Line 48 (may not exceed 1.0000)

qualifying

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52. Income tax liability (Subtract Line 11 from Line 6 )

jurisdiction(s)

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53. Multiply Line 51 by Line 52

or your credit

will be

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54. Income tax paid to a qualifying jurisdiction (See instructions, Page 21)

disallowed.

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55. Enter the lesser of Line 53 or Line 54

56. TOTAL CREDIT (Add Line 55, all columns)

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Enter this amount here and on Line 7 on the front of this form.

SCHEDULE 3

CREDIT FOR PROPERTY TAXES PAID ON YOUR PRIMARY RESIDENCE AND/OR MOTOR VEHICLE

Failure to complete this schedule could result in the disallowance of this credit.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

QUALIFYING

NAME OF

DESCRIPTION OF PROPERTY

LIST OR BILL

DATE(S) PAID

PROPERTY

NUMBER

(See instructions,

AMOUNT PAID

CONNECTICUT TAX

If primary residence, enter street address

If motor vehicle, enter year, make, and model

Page 22)

(If available)

TOWN OR DISTRICT

PRIMARY

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RESIDENCE

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AUTO 1

MARRIED FILING

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JOINTLY ONLY - AUTO 2

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60. TOTAL PROPERTY TAX PAID (Add all amounts for Column E)

61. MAXIMUM PROPERTY TAX CREDIT ALLOWED

500 00

Property

Tax Credit

62. Enter the Lesser of Line 60 or Line 61. (If $100 or less, enter this amount on Line 64. If greater than $100, go to Line 63.)

Calculation

63. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet (See Page 23)

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64. Subtract Line 63 from Line 62. Enter here and on Line 11 on the front of this form.

Do you authorize DRS to contact another person about this return? ( See Page 14 )

Yes. Complete the following.

Third 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.

Your Signature

Date

Daytime Telephone Number

(

)

Sign Here

Keep a copy

Spouse’s Signature (if joint return)

Date

Daytime Telephone Number

(

)