Form Ct-1040ez - Connecticut Resident Ez Income Tax Return

Complete this schedule if you have a Connecticut individual use tax liability. You owe use tax if you purchased taxable goods or services during the

taxable year and did not pay Connecticut sales tax on the purchases. Individual items with the purchase price of $300 or more must be listed separately

below. Although you do not need to list separately any individual item with a purchase price of less than $300, such items are subject to tax and the total

of the purchase prices of these items should be reported on Line A. Multiply the sales and use tax rate by the purchase price of the item and enter the

result in Column E.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

COLUMN F

COLUMN G

BALANCE DUE

TAX, IF ANY,

PURCHASE

CT TAX DUE

DATE OF

DESCRIPTION OF

RETAILER OR

(Col. E – Col. F but

PAID TO ANOTHER

PURCHASE

GOODS OR SERVICES

SERVICE PROVIDER

PRICE

(.06 X Column D)

not less than zero)

JURISDICTION

A. TOTAL OF INDIVIDUAL PURCHASES UNDER $300 NOT LISTED ABOVE

18.

(Add all amounts for Column G) Enter here and on Line 7 on the front of this form.

See Informational Publication 2000(21), Q & A on the Connecticut Individual Use Tax, for more information.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

QUALIFYING

NAME OF

DESCRIPTION OF PROPERTY

LIST OR BILL

DATE(S) PAID

PROPERTY

CONNECTICUT TAX

If primary residence, enter street address

(See instructions,

AMOUNT PAID

NUMBER

TOWN OR DISTRICT

If motor vehicle, enter year, make, and model

Page 11)

(if available)

PRIMARY

RESIDENCE

AUTO 1

MARRIED FILING

JOINTLY ONLY - AUTO 2

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

23. Maximum Property Tax Credit Allowed

500 00

24. Enter the Lesser of Line 22 or Line 23 (If $100 or less, enter this amount on Line 26. If greater than $100, go to Line 25).

25. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet . (See note below)

26. Subtract Line 25 from Line 24. Enter here and on Line 5 on the front of this form.

NOTE: Enter “0” on Line 25 and do not complete the Property Tax Credit Limitation Worksheet if your filing status is:

Single and your Connecticut AGI is $54,500 or less;

Married Filing Jointly and your Connecticut AGI is $100,500 or less;

Married Filing Separately and your Connecticut AGI is $50,250 or less;

Head of Household and your Connecticut AGI is $78,500 or less.

Otherwise, complete the Property Tax Credit Limitation Worksheet on the inside back cover of this booklet and enter the amount from the worksheet

on Line 25. DRS will help you calculate your property tax credit by using the Property Tax Credit Calculator on the DRS Web site at:

Do you authorize DRS to contact another person about this return? (See Page 9)

Yes. Complete the following.

Third Party

Designee’s Name

Telephone Number

Personal Identification

Designee

(

)

Number (PIN)

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.

Sign Here

Your Signature

Date

Daytime Telephone Number

(

)

Keep a

copy for

Spouse’s Signature (if joint return)

Date

Daytime Telephone Number

(