Schedule Ct-1041 K-1 - Beneficiary'S Share Of Certain Connecticut Items - 2013

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Department of Revenue Services
2013
State of Connecticut
Schedule CT-1041 K-1
(Rev. 12/13)
Benefi ciary’s Share of Certain Connecticut Items
For calendar year 2013 or other taxable year
beginning
, 2013, and
ending
, 20 ____.
___________________
____________________
Complete this schedule in blue or black ink only.
Trust or Estate Information
Benefi ciary Information
Federal Employer ID Number (FEIN)
Benefi ciary’s Social Security Number (SSN) or FEIN
SSN

FEIN
Name of trust or estate
Name
Name and title of fi duciary
Address
Number and street
PO Box
Address of fi duciary
Number and street
PO Box
City or town
State
ZIP code
City or town
State
ZIP code
Check one:
Resident, noncontingent
Nonresident, noncontingent
Check one:
Amended Schedule CT-1041 K-1
Resident, contingent
Nonresident, contingent
Final Schedule CT-1041 K-1
Part-year resident: See Instructions. Date:
%
Shares of federal distributable net income
$
00
Part I - Connecticut Fiduciary Adjustment
00
1. Connecticut fi duciary adjustment from Schedule CT-1041B, Part 1, Column 5 ........
1.
Part II - Connecticut-Sourced Portion of Items
From federal Schedule K-1
Connecticut-sourced portion
00
00
1. Interest income ........................................... ........................
1.
00
00
2a. Ordinary dividends ............................................................. 2a.
00
00
2b. Qualifi ed dividends ............................................................. 2b.
00
00
3. Net short-term capital gain .................................................
3.
00
00
4a. Net long-term capital gain .................................................. 4a.
00
00
4b. 28% rate gain ..................................................................... 4b.
00
00
4c. Unrecaptured section 1250 gain ........................................ 4c.
00
00
5. Other portfolio and nonbusiness income ...........................
5.
00
00
6. Ordinary business income ..................................................
6.
00
00
7 Net rental real estate income .............................................
7.
00
00
8. Other rental income ............................................................
8.
00
00
9. Directly apportioned deductions (attach statement) ...........
9.
Part III - Schedule CT-IT Credit
00
1. Qualifi ed small business tax credit ............................................................. ......................
1.
00
2. Job expansion tax credit....................................................................................................
2.
00
3. Angel investor tax credit ....................................................................................................
3.
00
4. Insurance reinvestment fund credit ...................................................................................
4.

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