Form Ct-1040ez - Connecticut Resident Ez Income Tax Return

Complete this schedule if you have a Connecticut individual use tax liability. You owe use tax if you purchased taxable goods or services during the

taxable year and did not pay Connecticut sales tax on the purchase. Individual items with the purchase price of $300 or more must be listed separately

below. Although you do not need to list separately any individual item with a purchase price of less than $300, such items are subject to tax and the total

of the purchase price of these items should be reported on Line A. Multiply the sales and use tax rate by the purchase price of the item and enter the

result in Column E.

COLUMN D

COLUMN E

COLUMN F

COLUMN G

COLUMN A

COLUMN B

COLUMN C

BALANCE DUE

TAX, IF ANY,

PURCHASE

CT TAX DUE

DATE OF

DESCRIPTION OF

RETAILER OR

(Col. E - Col. F but

PAID TO ANOTHER

PRICE

(.06 X Column D)

PURCHASE

ARTICLES OR SERVICES

SERVICE PROVIDER

not less than zero)

JURISDICTION

A. TOTAL OF INDIVIDUAL PURCHASES UNDER $300 NOT LISTED ABOVE

18.

(Add all amounts for Column G) Enter here and on Line 7 on the front of this form.

See Informational Publication 99(28), Q & A on the Connecticut Individual Use Tax, for more information.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

QUALIFYING

NAME OF

DESCRIPTION OF PROPERTY

LIST OR BILL

DATE PAID

PROPERTY

CONNECTICUT TAX

If primary residence, enter street address

AMOUNT PAID

NUMBER

(See instructions,

TOWN OR DISTRICT

If motor vehicle, enter year, make, and model

(if available)

page 14)

PRIMARY

RESIDENCE

AUTO 1

MARRIED FILING

JOINTLY ONLY - AUTO 2

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

425 00

23. Maximum Property Tax Credit Allowed

24. Enter the Lesser of Line 22 or Line 23 (If $100 or less, enter this amount on Line 26. If greater than $100, go to Line 25).

25. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet. (See note below)

26. Subtract Line 25 from Line 24. Enter here and on line 5 on the front of this form.

NOTE: If you meet any of the conditions below, enter 0 on Line 25 and go to Line 26:

Your filing status is Single and your Connecticut AGI is $52,500 or less;

Your filing status is Married Filing Jointly and your Connecticut AGI is $100,500 or less;

Your filing status is Married Filing Separately and your Connecticut AGI is $50,250 or less;

Your filing status is Head of Household and your Connecticut AGI is $78,500 or less.

Otherwise, complete the Property Tax Credit Limitation Worksheet on page 15 and enter the amount from the worksheet on Line 25.

DRS will help you calculate your property tax credit. See the Property Tax Credit Calculator on the DRS Web site at:

I declare under the penalties 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 taxpayer) is based on all information of which preparer has any knowledge.

Your Signature

Date

Spouse’s Signature (if joint return)

Date

Paid Preparer’s Signature

Date

Keep a

copy of

this return

Firm Name

Preparer’s EIN, SSN or PTIN

for your