Form C-3 - State Of Connecticut Domicile Declaration - Department Of Revenue Services
Download a blank fillable Form C-3 - State Of Connecticut Domicile Declaration - Department Of Revenue Services in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form C-3 - State Of Connecticut Domicile Declaration - Department Of Revenue Services with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Print Form
Reset Form
Department of Revenue Services
Form C-3
Estate Tax Section
State of Connecticut Domicile Declaration
PO Box 2972
Hartford CT 06104-2972
To be used by estates of decedents dying on or after January 1, 2010
(Rev. 05/10)
Decedent’s last name
First name and middle initial
Social Security Number (SSN)
• •
• •
• •
• •
__ __ __
__ __
__ __ __
Decedent’s residence on date of death (number and street)
Age at death
Date of death
City, town, or post office
State
ZIP code
Connecticut probate court
Year domicile
established
General Instructions: Generally, whenever a decedent is claimed to be a nonresident of Connecticut, the fiduciary of the decedent’s estate
must file Form C-3, State of Connecticut Domicile Declaration. All questions must be answered fully for the declaration to be considered
complete. For the estate of a decedent dying on or after January 1, 2010, Form C-3 must be filed with the Department of Revenue Services
(DRS) if the decedent’s Connecticut taxable estate is over $3.5 million and must be filed with the appropriate Connecticut Probate Court
if the decedent’s Connecticut taxable estate is $3.5 million or less as valued for federal estate tax purposes. Attach additional statements
as needed.
1. What is your relationship to the decedent? _______________________________________________________________________
No
If Yes, list periods: ______________________________________
2. Did the decedent ever live in Connecticut?
Yes
3. Did the decedent live part of the year in Connecticut and part of the year outside of Connecticut?
Yes
No
If Yes, list periods: __________________________________________________________________________________________
4. Identify and list the address of each piece of real estate owned by the decedent, the decedent’s spouse, or both, or a trust for the
five years preceding death. Indicate whether the decedent lived in a house that was rented or owned, apartment, condominium,
cooperative, hotel, nursing home, or in the home of relatives or friends. State the assessed and fair market value of real estate owned
by the decedent, the decedent’s spouse, or both, or a trust in the year of death.
Date
Owned
Assessed
Fair Market
Part
Full
(From - To)
Address/Town
State
or Rented
Description
Value
Value
Year
Year
5. List the states where the decedent was registered to vote during each of the five years preceding death and attach copies of voter
registration cards. List the latest year first. ______________________________________________________________________
6. Identify in which state(s) or political subdivisions of state(s) the decedent filed income tax, property tax, or intangible tax returns and
the taxes paid during the five years preceding death. Include the year(s) for which the returns were filed or tax paid. If an income tax
return was filed, note whether it was a resident or nonresident return.
Tax Year(s)
State or Political Subdivision
Tax Type
Tax Paid
Resident or Nonresident
7. Did the decedent file federal income tax returns?
Yes
No
If Yes, what was the decedent’s address on the returns? ___________________________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
N.y. Form M-3 - State Of New York Department Of Law Real Estate Finance Bureau Supplemental Broker Dealer Statement
Financial
Form Au-477 - Aircraft Owner/operator Declaration - Connecticut Department Of Revenue Services
Financial
Related Categories
Parent category: Financial