Form Ct-1040 - Connecticut Resident Income Tax Return - 2004 Page 3
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4Form CT-1040 - Page 3
Your Social
Security Number
Schedule 1 - Modifications to Federal Adjusted Gross Income
(Enter all items as positive numbers.)
(See Instructions, Page 18)
31. Interest on state and local government obligations other than Connecticut
31.
,
,
. 00
32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal
,
,
. 00
government obligations
32.
,
,
. 00
33. Special depreciation allowance for qualified property placed in service prior to Sept. 11, 2004 33.
34. Taxable amount of lump-sum distributions from qualified plans not included in federal
,
,
. 00
adjusted gross income
34.
,
,
. 00
35. Beneficiary's share of Connecticut fiduciary adjustment (Enter only if greater than zero)
35.
,
,
. 00
36. Loss on sale of Connecticut state and local government bonds
36.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
37. Allocated for future use
37.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
,
,
. 00
38. Other - specify
________________________________________________________
38.
,
,
. 00
39. Total Additions (Add Lines 31 through 38) Enter here and on Line 2.
39.
,
,
. 00
40. Interest on U.S. government obligations
40.
,
,
. 00
41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations 41.
42. Social Security benefit adjustment
,
,
. 00
(See Social Security Benefit Adjustment Worksheet, Page 20)
42.
,
,
. 00
43. Refunds of state and local income taxes
43.
,
,
. 00
44. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities
44.
,
,
. 00
45. Special depreciation allowance for qualified property placed in service during the preceding year
45.
,
,
. 00
46. Beneficiary's share of Connecticut fiduciary adjustment (Enter only if less than zero)
46.
,
,
. 00
47. Gain on sale of Connecticut state and local government bonds
47.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
48. Allocated for future use
48.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8
,
,
. 00
49. Other - specify (Do not include out of state income)
___________________________
49.
,
,
. 00
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 filed with the qualifying jurisdiction(s) or your credit will be disallowed.)
,
,
. 00
51. Modified Connecticut adjusted gross income
51.
(See instructions, Page 24)
COLUMN A
COLUMN B
Name
Code
Name
Code
52. Enter qualifying jurisdiction's name and two-letter code
(See instructions, Page 24)
52.
53. Non-Connecticut income included on Line 51 and
reported on a qualifying jurisdiction's income tax return
,
,
. 00
,
,
. 00
(Complete Schedule 2 Worksheet, Page 23)
53.
.
.
54. Divide Line 53 by Line 51 (may not exceed 1.0000)
54.
,
,
. 00
,
,
. 00
55. Income tax liability (Subtract Line 11 from Line 6)
55.
,
,
. 00
,
,
. 00
56. Multiply Line 54 by Line 55
56.
57. Income tax paid to a qualifying jurisdiction
,
,
. 00
,
,
. 00
(See instructions, Page 25)
57.
,
,
. 00
,
,
. 00
58. Enter the lesser of Line 56 or Line 57
58.
,
,
. 00
59.Total Credit (Add Line 58, all columns) Enter here and on Line 7. 59.
Complete applicable Schedules on Form CT-1040 - Page 4.
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