Form Ct-1040x - Amended Connecticut Income Tax Return For Individuals - 2001

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2001
Form CT-1040X
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
AMENDED CONNECTICUT INCOME TAX RETURN FOR INDIVIDUALS
(Rev. 12/01)
For the year January 1 - December 31, 2001, or other taxable year
beginning ______________ , 2001,
ending _______________ , _______ .
Social Security Number
Your First Name and Middle Initial
Last Name
__ __ __
__ __
__ __ __ __
• •
• •
• •
• •
Spouse’s Social Security Number
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
__ __ __
__ __
__ __ __ __
Please
• •
• •
• •
• •
Print
o r
Home Address (number and street), Apartment Number, PO Box
Your Telephone Number
Type
(
)
City, Town, or Post Office
State
ZIP Code
DEPARTMENT USE ONLY
– 20
Filing Status:
On original return:
Single
Married filing jointly/qualifying widow(er)
Married filing separately
Head of household
On this return:
Single
Married filing jointly/qualifying widow(er)
Married filing separately
Head of household
Are you amending your return as a result of federal or another state’s changes? (See instructions)
YES
NO
If YES, enter the date of federal change
/
/
OR enter the date of other state’s change
/
/
You must attach a copy of the IRS audit results, federal Form 1040X, the other state’s audit results or amended returns, and supporting documentation.
Enter in the space below the line number for each item you are changing and give the reason for each change. Attach supporting
forms and schedules for items changed. Write your name and Social Security Number on all attachments.
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
A.
B.
______________________________________________________________________
Original amount or as
Net change increase
C.
Correct amount
previously adjusted
or (decrease)
1. Federal Adjusted Gross Income (from federal Form 1040,
Line 33; Form 1040A, Line 19; Form 1040EZ, Line 4; or
federal TeleFile Tax Record, Line
I
) ............................................... 1
2. Additions, if any (If changed, see instructions) .............................. 2
Income
3. Add Line 1 and Line 2 ...................................................................... 3
4. Subtractions, if any (If changed, see instructions) ......................... 4
5. Connecticut Adjusted Gross Income (Subtract Line 4 from Line 3) 5
Residents go to Line 10; Nonresidents and Part-Year Residents go to Line 6
6. Enter your income from Connecticut sources from
Schedule CT-SI; (If less than or equal to zero, enter “0.”) ..................... 6
Nonresidents
7. Enter the greater of Line 5 or Line 6 (If zero, go to Line 10
and
and enter “0.”) ..................................................................................... 7
Part-Year
8. Income Tax (From Tax Calculation Schedule, see instructions) .... 8
Residents
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
9. Divide Line 6 by Line 5 (If Line 6 is equal to or greater than
Only
.
.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
Line 5, enter 1.0000.) ........................................................................ 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
10. Income Tax (See instructions) ........................................................ 10
11. Credit for income taxes paid to qualifying jurisdictions (If changed,
see instructions) Residents and Part-Year Residents only ........... 11
12. Subtract Line 11 from Line 10 ........................................................ 12
13. Connecticut Alternative Minimum Tax (from Form CT-6251) ..... 13
14. Add Line 12 and Line 13 ................................................................ 14
Tax
15. Credit for property tax paid on your primary residence and/or
motor vehicle. Residents only (See instructions) ....................... 15
16. Subtract Line 15 from Line 14 (If less than or equal to zero, enter “0.”) ... 16
17. Adjusted Net Connecticut Minimum Tax Credit (from Form CT-8801) .... 17
18. Connecticut Income Tax (Subtract Line 17 from Line 16) .......... 18
19. Individual Use Tax (If changed, see instructions) ....................... 19
20. Total Tax (Add Line 18 and Line 19) ............................................. 20
21. Connecticut tax withheld (If changed, see instructions ) .............. 21
22. All 2001 estimated Connecticut income tax payments (including any
overpayments applied from a prior year) and extension payments ..... 22
23. Amounts paid with original return, plus additional tax paid
Payments
after it was filed ................................................................................ 23
24. Total Payments (Add Lines 21, 22, and 23) .................................. 24
25. Overpayment, if any, as shown on original return (or as previously adjusted) ......................................................... 25
26. Subtract Line 25 from Line 24 ..................................................................................................................................... 26
Refund
27. If Line 26, Column C, is greater than Line 20, Column C, enter the amount overpaid
REFUND
27
28. If Line 20, Column C, is greater than Line 26, Column C, enter the amount you owe ......................................... 28
Amount
29. Interest (Multiply Line 28 by number of months or fraction thereof, then by 1% (.01)) .......................................... 29
You Owe
30. Amount you owe with this return (Add Line 28, Column C, and Line 29, Column C) AMOUNT YOU OWE
30
ATTACH A COPY OF ALL APPLICABLE SCHEDULES AND FORMS TO THIS RETURN
SEE MAILING INSTRUCTIONS ON REVERSE — TAXPAYERS MUST SIGN DECLARATION ON REVERSE

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