Form Ct-1040nr/py - Connecticut Nonresident And Part-Year Resident Income Tax Return - 2014 Page 3

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2014 Form CT-1040NR/PY - Page 3 of 4
Your Social
-
-
Security Number
Schedule 1 - Modifi cations to Federal Adjusted Gross Income
Enter all items as positive numbers.
See Instructions, Page 20.
00
.
,
,
33. Interest on state and local government obligations other than Connecticut
33.
34. Mutual fund exempt-interest dividends from non-Connecticut state or municipal
00
.
,
,
government obligations
34.
35. Reserved for future use.
35.
36. Taxable amount of lump-sum distributions from qualifi ed plans not included in federal
00
.
,
,
36.
adjusted gross income
00
.
,
,
37. Benefi ciary’s share of Connecticut fi duciary adjustment: Enter only if greater than zero.
37.
00
.
,
,
38. Loss on sale of Connecticut state and local government bonds
38.
39. Domestic production activity deduction from federal form 1040, Line 35
39.
00
.
,
,
.
00
40. Other - specify
________________________________________________________
40.
,
,
.
00
,
,
41. Total additions: Add Lines 33 through 40. Enter here and on Line 2.
41.
.
00
,
,
42. Interest on U.S. government obligations
42.
.
00
43. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations 43.
,
,
.
00
44. Social Security benefi t adjustment: See Social Security Benefi t Adjustment Worksheet, Page 22. 44.
,
,
.
00
45. Refunds of state and local income taxes
45.
,
,
.
00
46. Tier 1 and Tier 2 railroad retirement benefi ts and supplemental annuities
46.
,
,
.
00
47. 50% of military retirement pay
47.
,
,
.
00
48. Benefi ciary’s share of Connecticut fi duciary adjustment: Enter only if less than zero.
48.
,
,
.
00
49. Gain on sale of Connecticut state and local government bonds
49.
,
,
00
.
50. Connecticut Higher Education Trust (CHET) contributions
50.
,
,
Enter CHET account number:
Do not add spaces or dashes.
00
.
,
,
51. Other - specify: Do not include out of state income.
___________________________
51.
00
.
,
,
52. Total subtractions: Add Lines 42 through 51. Enter here and on Line 4.
52.
Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions - Part-Year Residents Only
You must attach a copy of your return fi led with the qualifying jurisdiction(s) or your credit will be disallowed.
00
.
,
,
53. Connecticut adjusted gross income during the residency portion of taxable year.
53.
See instructions, Page 26.
Column A
Column B
Name
Code
Name
Code
54. Enter qualifying jurisdiction’s name and two-letter
code. See instructions, Page 26.
54.
55. Non-Connecticut income included on Line 53 and
reported on a qualifying jurisdiction’s income tax
.
00
.
00
,
,
,
,
return: Complete Schedule 2 Worksheet, Page 25. 55.
.
.
56. Divide Line 55 by Line 53. May not exceed 1.0000. 56.
.
00
.
00
,
,
,
,
57. Apportioned income tax: See instructions, Page 26. 57.
.
00
.
00
,
,
,
,
58. Multiply Line 56 by Line 57.
58.
59. Income tax paid to a qualifying jurisdiction
00
00
.
.
,
,
,
,
See instructions, Page 26.
59.
00
00
.
.
,
,
,
,
60. Enter the lesser of Line 58 or Line 59.
60.
00
.
,
,
61. Total credit: Add Line 60, all columns. Enter here and on Line 11.
61.
Complete applicable schedules on Page 4 and send all four pages of the return to DRS.

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