Form Ct-1040 - Connecticut Resident Income Tax Return - 2004 Page 4

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Form CT-1040 - Page 4
Your Social
Security Number
Schedule 3 - PROPERTY TAX CREDIT WORKSHEET
Qualifying Property
Primary Residence
Auto 1
Auto 2 (Married Filing Jointly Only)
Name of Connecticut Tax
Town or District
Description of Property
If primary residence, enter
street address.
If motor vehicle, enter year,
make, and model.
List or Bill Number
(if available)
Date(s) Paid
_ _ /_ _ / 2004
_ _ /_ _ / 2004
_ _ /_ _ / 2004
(See instructions, Page 26)
_ _ /_ _ / 2004
_ _ /_ _ / 2004
_ _ /_ _ / 2004
.
00
.
00
.
00
Amount Paid
60.
61.
62.
,
,
,
00
.
,
63. Total Property Tax Paid (Add Lines 60, 61, and 62.)
63.
3 5 0 . 0 0
64. Maximum property tax credit allowed
64.
.
00
65. Enter the lesser of Line 63 or Line 64.
65.
66. Enter the decimal amount for your filing status and Connecticut AGI from the Property Tax Credit Table exactly
.
as it appears on Page 27. (If zero, enter amount from Line 65 on Line 68.)
66.
.
00
67. Multiply Line 65 by Line 66
67.
.
00
68. Subtract Line 67 from Line 65. Enter here and on Line 11.
68.
Schedule 4 - INDIVIDUAL USE TAX WORKSHEET
Complete this worksheet to calculate your Connecticut Individual Use Tax liability.
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
COLUMN F
COLUMN G
TAX, IF ANY,
BALANCE DUE
DATE OF
DESCRIPTION OF GOODS
RETAILER OR SERVICE
PURCHASE
CT TAX DUE
PAID TO
(Column E minus
PURCHASE
OR SERVICES
PROVIDER
PRICE
ANOTHER
(.06 X Column D)
Column F but not
JURISDICTION
less than zero)
Total of individual purchases under $300 not listed above
69. Individual Use Tax (Add all amounts for Column G.) Enter here and on
00
.
,
Form CT-1040, Line 15.
69.
Use envelope provided, with correct mailing label, or mail to:
For refunds and all other tax forms without payment:
For all tax forms with payment:
Department of Revenue Services
Department of Revenue Services
PO Box 2976
PO Box 2977
Hartford CT 06104-2976
Hartford CT 06104-2977
Make your check or money order payable to: “Commissioner of Revenue Services”
To ensure proper posting, write your SSN(s) and “2004 Form CT-1040” on your check or money order.

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