Form Ct-1040ez - Connecticut Resident Ez Income Tax Return - 2001
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2STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
EZ
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For the year January 1 - December 31, 2001, or other taxable year
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beginning _____________, 2001,
ending _____________, ______.
Your First Name and Middle Initial
Last Name
Social Security Number
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Use the
Spouse’s Social Security Number
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
DRS label
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located on
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cover.
IMPORTANT!
Home Address (number and street), Apartment Number, PO Box
Otherwise,
You MUST enter your SSN(s) above.
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print or type.
(See
City, Town, or Post Office
State
ZIP Code
DEPARTMENT USE ONLY
–
instructions,
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– 20
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Page 7)
T E L E F I L I N G , WEBFILING, O R E-F I L I N G M AY S P E E D Y O U R R E F U N D, see Page 4.
You may file Form CT-1040EZ if you meet ALL of the following conditions:
(See instructions, Page 6)
A. You were a resident of Connecticut for the entire taxable year; and
B. You did not report federally taxable Social Security benefits for the 2001 taxable year; and
C. You had no modifications to federal adjusted gross income or your only modification is a federally taxable refund of state
and local income tax; and
D. You are not claiming credit for income taxes paid to a qualifying jurisdiction; and
E. You do not have a federal alternative minimum tax liability and are not claiming an adjusted net Connecticut minimum tax credit.
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Check here if you do not want forms sent to you next year. Checking this box does not relieve you of your responsibility to file.
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NOTE: Generally, your filing status must be the same as your federal income tax filing status for this year. ( See instructions, Page 7 )
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A.
Single
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B.
Married filing joint return or Qualifying widow(er) with dependent child
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Check only
Married filing SEPARATE return __________________________________________
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one box.
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Spouse’s full name
Spouse’s Social Security Number
D.
Head of household (with qualifying person)
1. Federal Adjusted Gross Income (from federal Form 1040, Line 33; Form 1040A, Line 19;
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Form 1040EZ, Line 4; or federal TeleFile Tax Record, Line
)
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2. Refunds of state and local income taxes (from federal Form 1040, Line 10; see instructions, Page 8 )
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3.
(Subtract Line 2 from Line 1)
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4. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, Page 8)
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5. Credit for property taxes paid on your primary residence and/or motor vehicle. (You must complete
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Schedule 2 EZ on reverse and enter the amount from Line 26 here. See instructions, Page 8. )
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6.
(Subtract Line 5 from Line 4. If less than zero, enter “0.”)
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7.
(Complete Schedule 1 EZ on reverse) Enter the amount from Line 18 here.
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You must enter “0” on this line if no use tax is due. (See instructions, Page 8)
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8.
(Add Line 6 and Line 7)
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9. Connecticut tax withheld (Attach all W-2s and certain 1099s; see instructions, Page 8 )
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10. All 2001 estimated tax payments and any overpayments applied from a prior year
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11. Payments made with Form CT-1040 EXT (request for extension of time to file)
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12.
(Add Lines 9, 10, and 11)
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13. If Line 12 is greater than Line 8, enter amount overpaid. (Subtract Line 8 from Line 12)
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14. Amount of Line 13 you want applied to your 2002 estimated tax
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15. Amount of Line 13 you want to contribute to: (See instructions, Page 9)
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AIDS Research
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
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Organ Transplant
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
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Endangered Species/Wildlife
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
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Breast Cancer Research
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
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Safety Net Services
_____ $ 2
_____ $ 5
_____ $ 1 5
other ______ . 0 0
00
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Total Contributions
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16. Amount of Line 13 you want refunded to you. (Subtract Line 14 and Line 15 from Line 13)
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17. If Line 8 is greater than Line 12, subtract Line 12 from Line 8.
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(See instructions, Page 9)
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Check if paying by credit card
Use envelope provided, with correct mailing label, or mail to:
Make your check or money order payable to:
For all tax forms with payment –
For refunds and all other tax forms
Commissioner of Revenue Services
without payment –
Write your Social Security Number(s) and
Department of Revenue Services
Department of Revenue Services
“2001 Form CT-1040EZ” on your check or
PO Box 150420
PO Box 150440
money order.
Hartford CT 06115-0420
Hartford CT 06115-0440
Taxpayers must sign declaration on reverse — Due date: April 15, 2002 — Attach a copy of all applicable schedules and forms to this return.
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