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

SCHEDULE 1 MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME

(Enter all amounts as positive numbers)

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

32. Exempt-interest dividends from a mutual fund derived from state or municipal government

Additions to

obligations other than Connecticut

Federal

33. Shareholder’s pro rata share of S corporation nonseparately computed loss (See instructions, Page 3)

Adjusted

Gross Income

34. Taxable amount of lump-sum distributions from qualified plans not included in federal adjusted gross income

(See instructions,

35. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if greater than zero)

Page 2)

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

37. Other - specify _____________________________________________________________________

38. TOTAL ADDITIONS (Add Lines 31 through 37); Enter here and on Line 2, Column C, on the front of this form. 38

39. Interest on United States government obligations

40. Exempt dividends from certain qualifying mutual funds derived from United States government obligations

41. Social Security benefit adjustment ( See Social Security Benefit Adjustment Worksheet, Page 4)

Subtractions

From Federal

42. Refunds of state and local income taxes

Adjusted

43. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities

Gross Income

44. Shareholder’s pro rata share of S corporation nonseparately computed income (See instructions, Page 3)

(See instructions,

45. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if less than zero)

Page 2)

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

47. Other - specify (Do not include out-of-state income) _____________________________________

48. TOTAL SUBTRACTIONS (Add Lines 39 through 47); Enter here and on Line 4, Column C, on the front of this form. 48

SCHEDULE 2 CREDIT FOR INCOME TAXES PAID TO QUALIFYING JURISDICTIONS

(See instructions for Form CT-1040 or Form CT-1040NR/PY)

MODIFIED CONNECTICUT ADJUSTED GROSS INCOME

49.

COLUMN A

COLUMN B

FOR EACH COLUMN, ENTER THE FOLLOWING:

Important:

Name

Code

Name

Code

You must

50. Enter qualifying jurisdiction’s name and two-letter code

attach a copy

51. Non-Connecticut income included on Line 49 and reported on a qualifying

of your return

jurisdiction’s income tax return (from Schedule 2 Worksheet )

filed with the

qualifying

52. Divide Line 51 by Line 49 (may not exceed 1.0000)

jurisdiction(s)

53. Income tax liability (Subtract Line 15, Column C, from Line 10, Column C) 53

or your credit

54. Multiply Line 52 by Line 53

will be

disallowed.

55. Income tax paid to a qualifying jurisdiction

56. Enter the lesser of Line 54 or Line 55

57. TOTAL CREDIT (Add Line 56, all columns)

Enter here and on Line 11, Column C, on the front of this form.

SCHEDULE 3 (Connecticut Residents Only) - CREDIT FOR PROPERTY TAXES PAID ON YOUR PRIMARY RESIDENCE

AND/OR MOTOR VEHICLE - Failure to complete this schedule could result in the disallowance of this credit.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

DESCRIPTION OF PROPERTY

LIST OR BILL

NAME OF

DATE(S) PAID

AMOUNT PAID

QUALIFYING

NUMBER

CONNECTICUT

If primary residence, enter street address

(Enter date(s)

(Enter amount of

PROPERTY

(if available)

If motor vehicle, enter year, make, and model

you paid property

TAX TOWN OR

property tax paid.)

DISTRICT

tax.)

PRIMARY

RESIDENCE

AUTO 1

Married Filing

Jointly Only - AUTO 2

61. TOTAL PROPERTY TAX PAID (Add all amounts for Column E)

Property

62. MAXIMUM PROPERTY TAX CREDIT ALLOWED

5 0 0 00

Tax Credit

63. Enter the Lesser of Line 61 or Line 62. (If $100 or less, enter this amount on Line 65. If greater than $100, go to Line 64.)

Calculation

64. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet ( See Page 5 )

65. Subtract Line 64 from Line 63. Enter here and on Line 15, Column C, on the front of this form.

MAIL TO:

Department of Revenue Services

Make your check or money order payable to: Commissioner of Revenue Services

PO Box 2978

Write your Social Security Number(s) and “2001 Form CT-1040X” on your check or money order.

Hartford CT 06104-2978

I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and

belief, it is true, complete, and correct. I understand that the penalty for willfully delivering a false return to DRS is a fine of not more than $5,000, or imprisonment

for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any

knowledge.

Your Signature

Date

Spouse’s Signature (if joint return)

Date

Sign

Here

Paid Preparer’s Signature

Date

Telephone Number

Preparer’s SSN or PTIN

Keep a