Form Ct-W4p - Withholding Certificate For Pension Or Annuity Payments Page 2

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1999 CT-W4P ESTIMATED INCOME TAX WORKSHEET

(Use this worksheet if you wish to include all 1999 estimated income in determining withholding amount.)

1. Federal Adjusted Gross Income you expect in 1999 ....................................................................... 1. _______________________

2. Allowable Connecticut modifications (additions or subtractions, see instructions) ................. 2. _______________________

3. Connecticut Adjusted Gross Income (Combine Line 1 and Line 2) ............................................. 3. _______________________

IMPORTANT:

Nonresidents and part-year residents: Enter Connecticut source income if

greater than your Connecticut adjusted gross income.

4. Connecticut income tax (See instructions) ........................................................................................ 4. _______________________

5. Apportionment factor (Connecticut residents enter 1.0000. Nonresidents and part-year

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residents, see instructions) ................................................................................................................. 5. _______________________

6. Multiply Line 5 by Line 4 ........................................................................................................................ 6. _______________________

7. Credit for income taxes due to other jurisdictions (See instructions) .......................................... 7. _______________________

8. Subtract Line 7 from Line 6 .................................................................................................................. 8. _______________________

9. Estimated Connecticut alternative minimum tax (See instructions) ............................................. 9. _______________________

10. Add Line 8 and Line 9 .......................................................................................................................... 10. _______________________

11. Adjusted net Connecticut minimum tax credit (See instructions) ............................................... 11. _______________________

12. Subtract Line 11 from Line 10 ............................................................................................................ 12. _______________________

13. Connecticut income tax withheld or expected to be withheld in 1999 (on income other

than this pension or annuity) ............................................................................................................. 13. _______________________

14. Subtract Line 13 from Line 12. (IMPORTANT: If this amount is $500 or less,

you are not required to prepay this amount) ................................................................................... 14. _______________________

15. Amount to be withheld from each payment (divide Line 14 by the number of payments

you will receive in 1999). Round to the nearest whole dollar but not less than $10 .............. 15. _______________________

Form CT-W4P (Rev. 11/98)

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