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

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Department of Revenue Services
2013
Schedule CT K-1
State of Connecticut
Member’s Share of Certain Connecticut Items
(Rev. 12/13)
For calendar year 2013 or other taxable year
beginning _________________, 2013, and
ending _________________ , 20 ____.
Complete in blue or black ink only.
Pass-through entity (PE) information
Member information
Federal Employer ID Number (FEIN)
CT Tax Registration Number
Member’s Social Security Number (SSN) or FEIN
SSN
FEIN
Name
Name
Number and street address
PO Box
Number and street address
PO Box
City or town
State
ZIP code
City or town
State
ZIP code
Type of member (check one):
Check the box if this is an amended or a fi nal Schedule CT K-1.
RI
RE
RT
PE
Amended Schedule CT K-1
Final Schedule CT K-1
NI
NE
NT
CM
Part I - Connecticut Modifi cations
From Form CT-1065/CT-1120SI, Part V
Additions Enter all amounts as positive numbers.
00
1. Interest on state and local obligations other than Connecticut ..........................................................
1.
2. Mutual fund exempt-interest dividends from non-Connecticut state or municipal
00
government obligations .....................................................................................................................
2.
00
3. Certain deductions relating to income exempt from Connecticut income tax ....................................
3.
4. Reserved for future use .....................................................................................................................
4.
00
5. Other - specify ...................................................................................................................................
5.
Subtractions Enter all amounts as positive numbers.
00
6. Interest on U.S. government obligations ...........................................................................................
6.
00
7. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations .
7.
00
8. Certain expenses related to income exempt from federal income tax but subject to Connecticut tax ..
8.
9. Reserved for future use .....................................................................................................................
9.
00
10. Other – specify ..................................................................................................................................
10.
Part II - Connecticut-Sourced Portion of Items From
Column A
Column B
Federal Schedule K-1 of Form 1065 or 1120S
From Federal Schedule K-1
From Form CT-1065/CT-1120SI, Part VI
00
00
1. Ordinary business income (loss) ..................................................
1.
00
00
2. Net rental real estate income (loss) ..............................................
2.
00
00
3. Other net rental income (loss) ......................................................
3.
00
00
4. Guaranteed payments ..................................................................
4.
00
00
5. Interest income .............................................................................
5.
00
00
6a. Ordinary dividends ....................................................................... 6a.
00
00
6b. Qualifi ed dividends ....................................................................... 6b.
00
00
7. Royalties .......................................................................................
7.
00
00
8. Net short-term capital gain (loss) .................................................
8.
00
00
9a. Net long-term capital gain (loss) ................................................... 9a.
00
00
9b. Collectibles 28% gain (loss) ......................................................... 9b.
00
00
9c. Unrecaptured section 1250 gain .................................................. 9c.
00
00
10. Net section 1231 gain (loss) ......................................................... 10.
00
00
11. Other income (loss): Attach statement. ....................................... 11.
00
00
12. Section 179 deduction .................................................................. 12.
00
00
13. Other deductions: Attach statement. ........................................... 13.
Part III - Connecticut Income Tax Information
1. Member’s Connecticut income tax liability as reported by the PE for the member on
Form CT-1065/CT-1120SI, Part I, Schedule B, Column F .................................................................
1.
00

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