Form Ct-1041- Connecticut Income Tax Return For Trusts And Estates

SCHEDULE A - CONNECTICUT FIDUCIARY ADJUSTMENTS - (See instructions)

Additions

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

2. Exempt-interest dividends received from a mutual fund derived from state or municipal

government obligations other than Connecticut

3. Shareholder’s pro rata share of S corporation nonseparately computed loss (Enter as a

positive number)

4. Loss on sale of Connecticut state and local government bonds (Enter as a positive number)

5. Connecticut income tax payments deducted in determining federal taxable income prior

to deductions relating to distributions to beneficiaries

6. Other (Specify)

7. Total additions (Add Lines 1 through 6)

Subtractions

8. Interest on United States government obligations

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

obligations

10. Shareholder’s pro rata share of S corporation nonseparately computed income

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

12. Refunds of Connecticut income tax

13. Other (Specify)

14. Total subtractions (Add Lines 8 through 13)

15. Connecticut fiduciary adjustment - (Subtract Line 14 from Line 7. This amount may be positive or

negative) Enter on Form CT-1041, Schedule B , Part 1, Line f, Column 5.

Resident estates or full year resident trusts (except for those that meet the Quick-File

Requirements) must attach Form CT-1041, Schedule C and if applicable, Schedule CT-1041FA

Questions

If the trust is an inter vivos trust, enter name, address, and Social Security Number of grantor:

Name of grantor: ________________________________________________________________________________________

If you check “Part-year resident trust” on the front of this return, enter the date on which the trust

became irrevocable: ______________________________________________

C. Does the trust or estate have an interest in real property or tangible personal property located in

Yes

Connecticut?

Completed Schedules must be attached to the back of Form CT-1041 in the following order unless the trust or estate meets the

Quick-File Requirements on Page 14:

Schedule B

Schedule C

Schedule CT-1041FA

Schedule I

Form CT-8801

Credit for income taxes paid to other jurisdictions - Attach a copy of your return filed with other jurisdictions

or the credit will be disallowed.

Declaration: I declare under the penalty of false statement 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. (The penalty for false statement is imprisonment not to exceed one year or a fine not

to exceed two thousand dollars, or both.) Declaration of preparer (other than the taxpayer) is based on all information of which preparer has any knowledge.

Signature of Fiduciary or Officer Representing Fiduciary

Date

Telephone Number

Sign

Here

(

)

Paid Preparer’s Signature

Preparer’s PTIN or SSN

Keep a

copy of

this return