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Form CT-1040NR/PY - Page 3

Your Social

Security Number

Schedule 1 - Modifications to Federal Adjusted Gross Income

(Enter all items as positive numbers.)

(See Instructions, Page 20.)

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

33.

34. Mutual fund exempt-interest dividends from non-Connecticut state or municipal

government obligations

34.

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

35. Allocated for future use

35.

36. Taxable amount of lump-sum distributions from qualified plans not included in federal

36.

adjusted gross income

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

37.

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

38.

39. Allocated for future use

39.

40. Other - specify ________________________________________________________

40.

41. Total Additions (Add Lines 33 through 40.) Enter here and on Line 2.

41.

42. Interest on U.S. government obligations

42.

43. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations 43.

44. Social Security benefit adjustment (See Social Security Benefit Adjustment Worksheet, Page 21.)

44.

45. Refunds of state and local income taxes

45.

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

46.

47. Special depreciation allowance for qualified property placed in service during preceding year(s)

47.

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

48.

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

49.

50. Connecticut Higher Education Trust (CHET) contributions

50.

Enter CHET account number:

–

(can be up to 14 digits)

51. Other - specify (Do not include out of state income) ___________________________

51.

52. Total Subtractions (Add Lines 42 through 51.) Enter here and on Line 4.

52.

Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions - Part-Year Residents Only

(You must attach a copy of your return filed with the qualifying jurisdiction(s) or your credit will be disallowed.)

53. Connecticut Adjusted Gross Income during residency portion of taxable year.

53.

(See instructions, Page 26.)

Column A

Column B

Name

Code

Name

Code

54. Enter qualifying jurisdiction's name and two-letter

code (See instructions, Page 26.)

54.

55. Non-Connecticut income included on Line 53 and

reported on a qualifying jurisdiction's income tax

return (Complete Schedule 2 Worksheet, Page 25.)

55.

56. Divide Line 55 by Line 53 (May not exceed 1.0000)

56.

57. Apportioned Income tax (See instructions, Page 26.)

57.

58. Multiply Line 56 by Line 57.

58.

59. Income tax paid to a qualifying jurisdiction

(See instructions, Page 26.)

59.

60. Enter the lesser of Line 58 or Line 59.

60.

61. Total Credit (Add Line 60, all columns.) Enter here and on Line 11.

61.

Complete applicable schedules on Page 4

Form Ct-1040nr/py - Connecticut Nonresident And Part-Year Resident Income Tax Return - 2006 Page 3

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