Form Ct-1040nr/py - Connecticut Nonresident And Part-Year Resident Income Tax Return - 2014 Page 4

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2014 Form CT-1040NR/PY - Page 4 of 4
Your Social
-
-
Security Number
Schedule 3 - Individual Use Tax
Do you owe use tax for on-line or other purchases where you paid no sales tax?
See instructions, Page 36.
Failure to report and pay use tax is subject to as much as a $5,000 fi ne, imprisonment for as much as 5 years, or both.
Complete the Connecticut Individual Use Tax Worksheet on Page 37 to calculate your use tax liability.
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62a. Total use tax due at 1%: From Connecticut Individual Use Tax Worksheet, Section A, Column 7.
62a.
.
,
00
62b. Total use tax due at 6.35%: From Connecticut Individual Use Tax Worksheet, Section B, Column 7 62b.
.
,
.
00
62c. Total use tax due at 7%: From Connecticut Individual Use Tax Worksheet, Section C, Column 7
62c.
,
62. Individual use tax: Add Lines 62a through 62c. If no use tax is due, you must enter “0”
00
.
here and on Line 17.
62.
,
Schedule 4 - Contributions to Designated Charities
- See more information on Page 53.
00
.
63a. AIDS Research
63a.
,
,
00
.
63b. Organ Transplant
63b.
,
,
.
00
63c. Endangered Species/Wildlife
63c.
,
,
.
00
63d. Breast Cancer Research
63d.
,
,
00
.
63e. Safety Net Services
63e.
,
,
.
00
63f. Military Relief
63f.
,
,
.
00
63g. CHET Baby Scholar
63g.
,
,
.
00
63.
Total contributions: Add Lines 63a through 63g, enter amount here and on Line 26a.
63.
,
,
Complete and send all four pages of the return to DRS.
Use the correct mailing address for returns with a payment or requesting a refund.
For refunds and all other tax forms without payment:
For all tax forms with payment:
Department of Revenue Services
Department of Revenue Services
PO Box 2968
PO Box 2969
Hartford CT 06104-2968
Hartford CT 06104-2969
Make your check payable to Commissioner of Revenue Services
To ensure proper posting, write your SSN(s) (optional) and “2014 Form CT-1040NR/PY” on your check.

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