Form Ct-1040 - Connecticut Resident Income Tax Return

2012 Form CT-1040 - Page 3 of 4

Your Social



Security Number

Schedule 1 - Modiﬁ cations to Federal Adjusted Gross Income

Enter all items as positive numbers.

See instructions, Page 22.

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

31.

32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal

government obligations

32.

33. Reserved for future use.

33.

34. Taxable amount of lump-sum distributions from qualiﬁ ed plans not included in federal

adjusted gross income

34.

35. Beneﬁ ciary’s share of Connecticut ﬁ duciary adjustment: Enter only if greater than zero.

35.

36. Loss on sale of Connecticut state and local government bonds

36.

37. Domestic production activity deduction from federal Form 1040, Line 35

37.



38. Other - specify

________________________________________________________

38.

39. Total additions: Add Lines 31 through 38. Enter here and on Line 2.

39.

40. Interest on U.S. government obligations

40.

41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations

41.

42. Social Security beneﬁ t adjustment: See Social Security Beneﬁ t Adjustment Worksheet, Page 24. 42.

43. Refunds of state and local income taxes

43.

44. Tier 1 and Tier 2 railroad retirement beneﬁ ts and supplemental annuities

44.

45. 50% of military retirement pay

45.

46. Beneﬁ ciary’s share of Connecticut ﬁ duciary adjustment: Enter only if less than zero.

46.

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

47.

48. Connecticut Higher Education Trust (CHET) contributions

48.

Enter CHET account number:

Do not add spaces or dashes.



49. Other - specify: Do not include out of state income.

___________________________

49.

50. Total subtractions: Add Lines 40 through 49. Enter here and on Line 4.

50.

Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions

You must attach a copy of your return ﬁ led with the qualifying jurisdiction(s) or your credit will be disallowed.

51. Modiﬁ ed Connecticut adjusted gross income

51.

See instructions, Page 28.

Column A

Column B



Name

Code



Name

Code

52. Enter qualifying jurisdiction’s name and two-letter

code: See instructions, Page 28.

52.

53. Non-Connecticut income included on Line 51 and

reported on a qualifying jurisdiction’s income tax

return: Complete Schedule 2 Worksheet, Page 28. 53.

54. Divide Line 53 by Line 51. May not exceed 1.0000 54.

55. Income tax liability: Subtract Line 11 from Line 6. 55.

56. Multiply Line 54 by Line 55.

56.

57. Income tax paid to a qualifying jurisdiction

See instructions, Page 29.

57.

58. Enter the lesser of Line 56 or Line 57.

58.

59. Total credit: Add Line 58, all columns. Enter here and on Line 7.

59.

Complete applicable schedules on Page 4 and send all four pages of the return to DRS.

Form Ct-1040 - Connecticut Resident Income Tax Return - 2012 Page 3

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