Form Ct-1040x - Amended Connecticut Income Tax Return For Individuals

Reason(s) for amending return: Enter the line number for each item you are changing and give the reason for each change in the space below. Attach

supporting forms and schedules for items changed. Write your name and SSN(s) on all attachments.

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Schedule 1 Modiﬁ cations to Federal Adjusted Gross Income Enter all amounts as positive numbers.

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31. Interest on state and local government obligations other than Connecticut

32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government

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obligations other than Connecticut

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Additions

33. Reserved for future use.

to Federal

34. Taxable amount of lump-sum distributions from qualiﬁ ed plans not included in federal adjusted

Adjusted

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gross income

Gross

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35. Beneﬁ ciary’s share of Connecticut ﬁ duciary adjustment: Enter only if greater than zero.

Income

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36. Loss on sale of Connecticut state and local government bonds

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37. Domestic production activity deduction from federal form 1040, Line 35

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38. Other - specify

39. Total additions: Add Lines 31 through 38.

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Enter here and on Line 2, Column C, on the front of this form.

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40. Interest on U.S. government obligations

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41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations

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42. Social Security beneﬁ t adjustment from Social Security Beneﬁ t Adjustment Worksheet

Subtractions

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43. Refunds of state and local income taxes

From

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44. Tier 1 and Tier 2 railroad retirement beneﬁ ts and supplemental annuities

Federal

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45. 50% of military retirement pay

Adjusted

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46. Beneﬁ ciary’s share of Connecticut ﬁ duciary adjustment: Enter only if less than zero.

Gross

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47. Gain on sale of Connecticut state and local government bonds

Income

48. Contributions to a Connecticut Higher Education Trust (CHET) account

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Enter CHET account number:

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Do not add spaces or dashes.

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49. Other - specify: Do not include out-of-state income.

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50. Total subtractions: Add Lines 40 through 49. Enter here and on Line 4, Column C.

Schedule 2 Credit for Income Taxes Paid to Qualifying Jurisdictions - Residents and Part-Year Residents Only

See instructions for Form CT-1040 or Form CT-1040NR/PY.

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51. Modiﬁ ed Connecticut Adjusted Gross Income

Column A

Column B

For each column, enter the following:

You must

Name

Code

Name

Code

attach a copy

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52. Enter qualifying jurisdiction’s name and two-letter code.

of your return

53. Non-Connecticut income included on Line 51 and reported on a

ﬁ led with the

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qualifying jurisdiction’s income tax return from Schedule 2 Worksheet.

qualifying

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54. Divide Line 53 by Line 51. May not exceed 1.0000.

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jurisdiction(s)

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55. Income tax liability: Subtract Line 15, Column C, from Line 10, Column C.

or your

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56. Multiply Line 54 by Line 55.

credit will be

disallowed.

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57. Income tax paid to a qualifying jurisdiction.

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58. Enter the lesser of Line 56 or Line 57.

59. Total credit: Add Line 58, all columns.

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Enter here and on Line 11, Column C.

Mail to:

Department of Revenue Services

Make your check payable to Commissioner of Revenue Services. To ensure proper posting of your

payment, write your Social Security Number(s) (SSN) (optional) and “2014 Form CT-1040X” on your

PO Box 2978

check. The Department of Revenue Services (DRS) may submit your check to your bank electronically.

Hartford CT 06104-2978

Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and

belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a ﬁ ne of not more than $5,000, imprisonment

for not more than ﬁ ve years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.

Your signature

Date

Home/cell telephone number

(

)

Sign

Your email address

here.

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Keep a

copy for

Spouse’s signature (if joint return)