Form Ct-1040nr/py - Nonresident Or Part-Year Resident Income Tax Return - 1999
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1
2STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
Check here for 1999 resident status:
Nonresident
Part-Year Resident
For the year January 1 - December 31, 1999, or other taxable year
beginning _____________, 1999,
ending _____________, _____.
Your First Name and Middle Initial
Last Name
Your Social Security Number
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__ __ __ __ __ __ __ __ __
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• •
Use the
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
Your Spouse’s Social Security Number
DRS label
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__ __ __ __ __ __ __ __ __
located on
• •
• •
the inside of
Home Address
Number and Street
Apt. No.
PO Box
this booklet.
Otherwise,
please print
City, Town or Post Office
State
ZIP Code
Your Telephone Number
or type.
(
)
(See
instructions,
Check here if you do not want forms sent to you next year. Checking this box does not relieve you
page13)
of your responsibility to file .......................................................................................................................................
If you are required to file Form CT-2210 and checked any boxes on Part 1, check here ..................................
A.
Single
B.
Married filing joint return or Qualifying widow(er) with dependent child
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
___________________________
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Check only
C.
Married filing SEPARATE return
one box.
D.
Head of household (with qualifying person)
1. Federal Adjusted Gross Income (from federal Form 1040, Line 33; Form 1040A, Line 18;
Form 1040EZ, Line 4; or TeleFile Tax Record, Line
I
)
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2. Additions, if any (from Schedule 1 , Line 39 on reverse)
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3. Add Line 1 and Line 2
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4. Subtractions, if any (from Schedule 1 , Line 49 on reverse)
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5. Connecticut Adjusted Gross Income (Subtract Line 4 from Line 3)
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6. Income from Connecticut sources (from Schedule CT-SI , Line 26)
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7. Enter the greater of Line 5 or Line 6 (If zero or less, go to Line 12 and enter 0)
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8. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, page 14)
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9. Divide Line 6 by Line 5 (If Line 6 is equal to or greater than Line 5, enter 1.0000)
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10. Multiply Line 9 by Line 8
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11. Credit for income taxes paid to other jurisdictions by part-year residents only (from Schedule 2 )
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12. Subtract Line 11 from Line 10 (If Line 11 is greater than Line 10, enter 0)
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13. Connecticut Alternative Minimum Tax (from Form CT-6251)
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14. Add Line 12 and Line 13
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15. Adjusted Net Connecticut Minimum Tax Credit (from Form CT-8801)
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16. Connecticut Income Tax (Subtract Line 15 from Line 14. If less than zero, enter 0.)
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17. Individual Use Tax. (Complete the Individual Use Tax Worksheet.) You must enter 0 on
this line if no use tax is due. (See instructions, page 14)
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18. Total Tax (Add Line 16 and Line 17)
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19. Connecticut tax withheld (Attach all W-2s and certain 1099s; see instructions, page 14 )
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20. All 1999 estimated tax payments and any overpayments applied from a prior year
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21. Payments made with extension request (Form CT-1040 EXT)
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22. Total payments (Add Lines 19, 20, and 21)
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23. If Line 22 is greater than Line 18, enter amount overpaid. (Subtract Line 18 from Line 22)
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24. Amount of Line 23 you want applied to your 2000 estimated tax
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25. Amount of Line 23 you want to contribute to:
(See instructions, page 15)
AIDS Research
____ $2
____ $5
______ $15
other ____________ .00
Organ Transplant
____ $2
____ $5
______ $15
other ____________ .00
Endangered Species/Wildlife
____ $2
____ $5
______ $15
other ____________ .00
Breast Cancer Research
____ $2
____ $5
______ $15
other ____________ .00
Safety Net Services
____ $2
____ $5
______ $15
other ____________ .00
00
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26. Amount of Line 23 you want refunded to you (Subtract Line 24 and Line 25 from Line 23)
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27. If Line 18 is greater than Line 22, enter the amount of tax you owe. (Subtract Line 22 from Line 18)
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28. If late: Enter Penalty (Multiply Line 27 by 10% (.10))
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29. If late: Enter Interest (Multiply Line 27 by number of months late or fraction thereof, then by 1% (.01))
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30. Interest on underpayment of estimated tax (from Form CT-2210; see instructions, page 16 )
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31. Amount you owe with this return (Add Lines 27 through 30)
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SEE PAYMENT AND MAILING INSTRUCTIONS ON REVERSE
TAXPAYERS MUST SIGN DECLARATION ON REVERSE
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