Form Ct-1040 - Connecticut Resident Income Tax Return - 2003 Page 2
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1
2Schedule 1 Modifications To Federal Adjusted Gross Income ( enter all amounts as positive numbers )
" 30
00
30. Interest on state and local government obligations other than Connecticut
" 31
00
31. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government obligations
Additions
" 32
00
32. Special depreciation allowance for qualified property placed in service during this year
to Federal
Adjusted
33. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted gross income " 33
00
Gross
" 34
00
34. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if greater than zero)
Income (See
instructions,
" 35
00
35. Loss on sale of Connecticut state and local government bonds
Page 18)
" 36
00
36. Other - specify __________________________________________________________________________
" 37
00
37. TOTAL ADDITIONS (Add Lines 30 through 36) Enter here and on Line 2.
" 38
00
38. Interest on U.S. government obligations
" 39
00
39. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations
" 40
00
40. Social Security benefit adjustment (See Social Security Benefit Adjustment Worksheet, Page 20)
Subtractions
" 41
00
41. Refunds of state and local income taxes
from Federal
Adjusted
" 42
00
42. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities
Gross
" 43
00
43. Special depreciation allowance for qualified property placed in service during the preceding year
Income (See
instructions,
" 44
00
44. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if less than zero)
Page 19)
" 45
00
45. Gain on sale of Connecticut state and local government bonds
" 46
00
46. Other - specify (Do not include out-of-state income) ___________________________________________
" 47
00
47. TOTAL SUBTRACTIONS (Add Lines 38 through 46) Enter here and on Line 4.
Schedule 2 Credit for Income Taxes Paid to Qualifying Jurisdictions
" 48
48. MODIFIED CONNECTICUT ADJUSTED GROSS INCOME (See instructions, Page 24)
00
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
00
00
jurisdiction’s income tax return (Complete Schedule 2 Worksheet, Page 23 ) " 50
"
with the
.
.
qualifying
" 51
"##
51. Divide Line 50 by Line 48 (May not exceed 1.0000)
jurisdiction(s)
00
00
" 52
"
or your
52. Income tax liability (Subtract Line 11 from Line 6 )
credit
00
00
" 53
"
53. Multiply Line 51 by Line 52
will be
" 54
00
"
00
disallowed.
54. Income tax paid to a qualifying jurisdiction (See instructions, Page 25)
" 55
00
"
00
55. Enter the lesser of Line 53 or Line 54
00
" 56
56. TOTAL CREDIT (Add Line 55, all columns) Enter here and on Line 7.
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 25)
If motor vehicle, enter year, make, and model
Town or District
(If available)
PRIMARY
"
00
57
RESIDENCE
"
00
AUTO 1
58
MARRIED FILING
"
00
59
JOINTLY ONLY - AUTO 2
"
00
60. TOTAL PROPERTY TAX PAID (Add all amounts for Column E)
60
Property
350 00
61. MAXIMUM PROPERTY TAX CREDIT ALLOWED
61
Tax
00
62. Enter the Lesser of Line 60 or Line 61.
62
Credit
63. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet (See Page 27)
00
Calculation
63
"
64. Subtract Line 63 from Line 62. Enter here and on Line 11.
00
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. 12/03)
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