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2004

Form CT-1040NR/PY

2 0

FOR DRS

USE ONLY

1040NR/PY

Connecticut Nonresident or Part-Year Resident Income Tax Return

2004

For the year January 1 - December 31, 2004, or other taxable year beginning: _________________ ,

and ending: ________________ , ______ .

Your Social Security Number

Filing Status

Single

Married filing jointly

Married filing SEPARATELY.

Head of

or Qualified

Enter spouse’s SSN at left

household

Spouse's Social Security Number

widow(er) with

and full name here:

(with qualifying

dependent child

person)

Your First Name

Last Name

Suffix

Spouse's First Name

Last Name

Suffix

Home Address (number and street)

Check here for 2004

resident status:

Nonresident

Apartment Number, PO Box, Suite Number

Part-Year Resident

City, Town, or Post Office

State

ZIP Code

Check here if you do not want forms sent to you next year.

Check here if you are required to file Form CT-2210 and checked

Checking this box does not relieve you of your responsibility to file.

any boxes on Part 1 of that form.

Whole Dollar

s Only

Whole Dollar

Whole Dollars Only

s Only

1. Federal adjusted gross income (from federal Form 1040, Line 36;

Form 1040A, Line 21; Form 1040EZ, Line 4; or federal Telefile, Line

)

2. Additions to federal adjusted gross income (from Schedule 1, Line 41)

3. Add Line 1 and Line 2.

4. Subtractions from federal adjusted gross income (from Schedule 1, Line 52)

5. Connecticut Adjusted Gross Income (Subtract Line 4 from Line 3.)

6. Income from Connecticut sources (from Schedule CT-SI, Line 29)

7. Enter the greater of Line 5 or Line 6 (If zero or less, go to Line 12 and enter “0.”) 7.

8. Income Tax (from Tax Tables or Tax Calculation Schedule, see instructions, Page 14) 8.

9. Divide Line 6 by Line 5 (If Line 6 is equal to or greater than Line 5, enter 1.0000)

10. Multiply Line 9 by Line 8

10.

11. Credit for income taxes paid to qualifying jurisdictions during resident portion of

taxable year. (For Part-Year Residents Only from Schedule 2, Line 61)

11.

12. Subtract Line 11 from Line 10 (If Line 11 is greater than Line 10, enter "0.")

12.

13. Connecticut Alternative Minimum Tax (from Form CT-6251)

13.

14. Add Line 12 and Line 13.

14.

15. Adjusted Net Connecticut Minimum Tax Credit (from Form CT-8801)

15.

16. Connecticut Income Tax (Subtract Line 15 from Line 14. If less than zero, enter “0.”) 16.

17. Individual Use Tax (from Schedule 3, Line 62. If no tax is due, enter “0.”)

17.

18. Total Tax (Add Line 16 and Line 17.)

18.

Taxpayers must sign declaration on reverse side.

Due date: April 15, 2005 - Attach a copy of all applicable schedules and forms to this return.

E-FILE YOUR RETURN FOR FASTER REFUND, see Page 4 of booklet.

Form Ct-1040nr/py - Connecticut Nonresident Or Part-Year Resident Income Tax Return - 2004

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