Form Ct-1040ez - Connecticut Resident Ez Income Tax Return - 1999
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2STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
For the year January 1 - December 31, 1999, or other taxable year
beginning _____________, 1999,
ending _____________, ______.
Your First Name and Middle Initial
Last Name
Social Security Number
• •
• •
• •
• •
Use the
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
Spouse’s Social Security Number
DRS label
• •
• •
located on
• •
• •
the inside of
Home Address
Number and Street
Apt. No.
this booklet.
Otherwise,
please print
City, Town or Post Office
State
ZIP Code
Your Telephone Number
or type.
(See
instructions,
(See instructions, page 6)
page 11)
A. You have no modifications to Federal Adjusted Gross Income for Connecticut income tax purposes; or your only modification is a
federally taxable refund of state and local income taxes;
B. You were a resident of Connecticut for the entire taxable year;
C. You are not claiming credit for income taxes paid to another jurisdiction;
D. You do not have a federal alternative minimum tax liability, and you are not claiming an adjusted net Connecticut minimum tax credit.
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............................................................................................................
NOTE: Your filing status must be the same as your federal income tax filing status for this year. (See instructions, page 11)
A.
Single
B.
Married filing joint return or Qualifying widow(er) with dependent child
• •
• •
Check only
• •
• •
C.
Married filing SEPARATE return __________________________________________
___________________________________________
one box.
Spouse’s full name
Spouse’s Social Security Number
D.
Head of household (with qualifying person)
1. Federal Adjusted Gross Income (from federal Form 1040, Line 33; Form 1040A, Line 18;
Form 1040EZ, Line 4; or TeleFile Tax Record, Line
I
)
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2. Refunds of state and local income taxes (from federal Form 1040, Line 10; see instructions, page 11)
2
3. Connecticut Adjusted Gross Income (Subtract Line 2 from Line 1)
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4. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, page 11)
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5. Credit for property taxes paid on your primary residence and/or motor vehicle. (You must complete
Schedule 2 EZ on reverse.) Enter the amount from Line 26 here. (See instructions, page 11)
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6. Connecticut Income Tax (Subtract Line 5 from Line 4. If less than zero, enter 0.)
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7.
(Complete Schedule 1 EZ on reverse) Enter the amount from Line 18 here.
You must enter 0 on this line if no use tax is due. (See instructions, page 12)
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8. Total Tax (Add Line 6 and Line 7)
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9. Connecticut tax withheld (
; see instructions, page 12)
9
10. All 1999 estimated tax payments and any overpayments applied from a prior year
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11. Payments made with extension request (Form CT-1040 EXT)
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12. Total payments (Add Lines 9, 10 and 11)
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13.
, enter amount overpaid. (Subtract Line 8 from Line 12)
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14. Amount of Line 13 you want applied to your 2000 estimated tax
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15. Amount of Line 13 you want to contribute to: (See instructions, page 12)
AIDS Research
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
Organ Transplant
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
Endangered Species/Wildlife
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
Breast Cancer Research
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
Safety Net Services
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
00
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16. Amount of Line 13 you want refunded to you
(Subtract Line 14 and Line 15 from Line 13)
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17.
, enter the amount of tax you owe.
(Subtract Line 12 from Line 8. See instructions, page 12)
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For refund request or no tax due, mail to:
For payment, mail to:
Make your check or money order payable to:
Department of Revenue Services
Department of Revenue Services
COMMISSIONER OF REVENUE SERVICES
PO Box 150420
PO Box 150440
Write your Social Security Number(s) and
Hartford CT 06115-0420
Hartford CT 06115-0440
“1999 Form CT-1040EZ" on your check or
money order.
Mail in the envelope provided with the correct label affixed.
Taxpayers must sign declaration on reverse — Due date: April 18, 2000 — Attach a copy of all applicable schedules and forms to this return.
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