Schedule Ct-1040aw Draft - Part-Year Resident Income Allocation - 2014

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Department of Revenue Services
2014
Schedule CT-1040AW
State of Connecticut
Part-Year Resident Income Allocation
(Rev. 12/14)
Part-year residents must complete this schedule before completing Schedule CT-SI and attach it to Form CT-1040NR/PY. Complete in blue or black ink only.
Your Social Security Number
Your fi rst name and middle initial
Last name
__ __ __ __ __ __ __ __ __
• •
• •
Spouse’s Social Security Number
If joint return, spouse’s fi rst name and middle initial
Last name
• •
• •
__ __ __ __ __ __ __ __ __
Part 1 – Adjusted Gross Income
Federal Income
Connecticut
Connecticut
as Modifi ed
Nonresident Period
Resident Period
See instructions.
Column A
Column C
Column D
Column B
Income from
Income from Column A
Income from Column C
Income from Column A
for this period
from Connecticut sources
federal return
for this period
1
1. Wages, salaries, tips, etc. .......................................
2
2. Taxable interest .......................................................
3
3. Ordinary dividends ..................................................
4
4. Alimony received ....................................................
5
5. Business income or (loss) .......................................
6
6. Capital gain or (loss) ...............................................
7
7. Other gains or (losses) ...........................................
8
8. Taxable amount of IRA distributions .......................
9
9. Taxable amount of pensions and annuities .............
10. Rental real estate, royalties, partnerships,
S corporations, trusts, etc. ...................................... 10
11. Farm income or (loss) .............................................
11
12. Unemployment compensation ................................ 12
13. Taxable amount of social security benefi ts ............. 13
14. Other income: See instructions. ............................. 14

00
00
00
00
15. Add Lines 1 through 14. . .....................................
15
Part 2 – Adjustments to Income
16. Reserved for future use .......................................... 16
17. Certain business expenses of reservists, performing
artists, and fee-basis government offi cials .............. 17
18. Health savings account deduction .......................... 18
19. Moving expenses .................................................... 19
20. Deductible part of self-employment tax .................. 20
21. Self-employed SEP, SIMPLE, and qualifi ed plans .. 21
22. Self-employed health insurance deduction ............. 22
23. Penalty on early withdrawal of savings ................... 23
24. Alimony paid ........................................................... 24
25. IRA deduction ......................................................... 25
26. Student loan interest deduction .............................. 26
27. Reserved for future use .......................................... 27
28. Reserved for future use .......................................... 28
29. Total adjustments: Add Lines 16 through 28. . ........ 29

00
00
00
00
30. Subtract Line 29 from Line 15. . ...........................
30
Line 30, Column A, must equal the amount on Form CT-1040NR/PY, Line 5.
Add Columns B and D for each line and enter the totals on Lines 1 through 30 on Schedule CT-SI.
Part 3 – Part-Year Resident Information
Moved Into Connecticut
/
/
1. Date you moved into Connecticut
and state of prior residence:
/
/
2. Date your spouse moved into Connecticut
and state of prior residence:
Moved Out of Connecticut
/
/
1. Date you moved out of Connecticut
and state of new residence
:
/
/
2. Date your spouse moved out of Connecticut
and state of new residence
:
Income From Connecticut Sources During Nonresident Period

1. Did you receive income from Connecticut sources during your nonresident period? ....................................................
Yes
No
2. Did your spouse receive income from Connecticut sources during his or her nonresident period? .............................
Yes
No
P:\Special\AFP\PROD\FORMS\14\Schedule\Schedule CT-1040AW\Schedule CT-1040AW 20140911.indd
20140911
11:40 AM

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