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

2003

State of Connecticut

Form CT-1040EZ

Department of Revenue Services

Connecticut Resident EZ Income Tax Return

For the year January 1 - December 31, 2003, or other taxable year

beginning _____________, 2003,

ending _____________, ______.

Label

Your First Name and Middle Initial

Last Name

Your Social Security Number

__ __ __

__ __

__ __ __ __

• •

Use the

DRS label

Spouse’s Social Security Number

If a JOINT Return, Spouse’s First Name and Initial

Last Name

__ __ __

__ __

__ __ __ __

located on

• •

cover.

IMPORTANT!

Home Address (number and street), Apartment Number, PO Box

Otherwise,

You MUST enter your SSN(s) above.

print or type.

(See

City, Town, or Post Office

State

ZIP Code

DRS USE ONLY

instructions,

–

– 20

Page 7)

WEBFILING OR

WEBFILING OR ELECTRONIC FILING

ELECTRONIC FILING

WEBFILING OR

ELECTRONIC FILING

WEBFILE

WEBFILE OR

E-FILE

E-FILE Y Y Y Y Y OU

WEBFILE

OR E-FILE

E-FILE

OUR R R R R RETUR

RETUR

RETURN N N N N FO

FOR R R R R F F F F F ASTE

ASTE

ASTER R R R R REFUND

REFUND

REFUND, , , , , see

see

see P P P P P a a a a a g g g g g e e e e e 3 3 3 3 3 . . . . .

MAY SPEED Y

Y SPEED Y

Y SPEED YOUR REFUND

OUR REFUND

OUR REFUND, see P

, see P

, see Pa a a a a g g g g g e X.

, see P

e X.

Y SPEED Y

OUR REFUND

, see P

e X.

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 .........................................................................................................................................................................

You may file Form CT-1040EZ if you meet ALL of the following conditions: (See instructions, Page 6)

You were a resident of Connecticut for the entire taxable year; and

Who May

You did not report federally taxable Social Security benefits for the 2003 taxable year; and

File Form

You had no modifications to federal adjusted gross income or your only modification is a federally taxable refund of state

CT-1040EZ

and local income tax; and

You are not claiming credit for income taxes paid to a qualifying jurisdiction; and

You do not have a federal alternative minimum tax liability and are not claiming an adjusted net Connecticut minimum tax credit.

NOTE: Generally, your filing status must be the same as your federal income tax filing status for this year (See instructions, Page 8) .

Filing

Married filing SEPARATELY. Enter spouse’s SSN above and full

Single

Status

name here: _____________________________________________

Check only

Married filing jointly or Qualifying

Head of household (with qualifying person)

one box.

widow(er) with dependent child

1. Federal Adjusted Gross Income (From federal Form 1040, Line 34; Form 1040A, Line 21;

Form 1040EZ, Line 4; or federal TeleFile Tax Record, Line

)

Income

2. Refunds of state and local income taxes (From federal Form 1040, Line 10. See instructions, Page 8. )

3. Connecticut Adjusted Gross Income (Subtract Line 2 from Line 1)

4. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, Page 8)

5. Credit for property taxes paid on your primary residence and/or motor vehicle. (You must complete

Schedule 1 EZ, on reverse. Enter the amount from Line 25. See instructions, Page 8. )

Tax

6. Connecticut Income Tax (Subtract Line 5 from Line 4. If less than zero, enter “0.”)

7. Individual Use Tax (From Schedule 2 EZ, Line 26)

8. Total Tax (Add Line 6 and Line 7)

Payments

9. Connecticut tax withheld (From Schedule CT-1040WH , Line 3. See instructions, Page 8. )

Failure to

10. All 2003 estimated tax payments and any overpayments applied from a prior year

attach W-2s

will result in the

11. Payments made with Form CT-1040 EXT (Request for extension of time to file)

disallowance of

12. Total Payments (Add Lines 9, 10, and 11)

withholding.

13. If Line 12 is greater than Line 8, enter amount overpaid. (Subtract Line 8 from Line 12)

Refund

14. Amount of Line 13 you want applied to your 2004 estimated tax

15. Amount of Line 13 you want to contribute to charity (From Schedule 3 EZ, Line 27) Total Contributions

REFUND

16. Amount of Line 13 you want refunded to you. (Subtract Lines 14 and 15 from Line 13)

For faster refund, choose direct deposit and complete Lines 16a, 16b, and 16c.

Type of Account: !"" Checking

To Direct Deposit

16a.

Savings

your refund, you must

16b. !

complete Lines 16a,

16c.!

16b, and 16c.

Routing Number

Account Number

Amount

17. If Line 8 is greater than Line 12, enter the amount of tax you owe. (Subtract Line 12 from Line 8)

You Owe

Check if paying by credit card

(See instructions, Page 9)

AMOUNT YOU OWE

Make your check or money order payable to:

Use envelope provided, with correct mailing label, or mail to:

“Commissioner of Revenue Services”

For refunds and all other tax forms without payment:

For all tax forms with payment:

To ensure proper posting, write your

Department of Revenue Services

SSN(s) and “2003 Form CT-1040EZ” on

PO Box 150420

PO Box 150440

your check or money order.

Hartford CT 06115-0420

Hartford CT 06115-0440

Taxpayers must sign declaration on reverse — Due date: April 15, 2004 — Attach a copy of all applicable schedules and forms to this return.

Form Ct-1040ez - Connecticut Resident Ez Income Tax Return - 2003

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