Form Ct-1041 - Connecticut Income Tax Return For Trusts And Estates For Residents, Nonresidents, And Part-Year Residents - 2013 Page 2
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1
2Schedule A - Connecticut Fiduciary Adjustments: See instructions.
Additions
00
1. Interest on state and local government obligations other than Connecticut
1
2. Mutual fund exempt-interest dividends from state or municipal government obligations other than
00
Connecticut
2
00
3. Loss on sale of Connecticut state and local government bonds: Enter as a positive number.
3
4. Connecticut income tax payments deducted in determining federal taxable income prior to deductions
00
relating to distributions to benefi ciaries
4
00
5. Other (Specify) __________________________________________________________________
5
00
6. Total additions: Add Lines 1 through 5.
6
Subtractions
00
7. Interest on U.S. government obligations
7
00
8. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations
8
00
9. Gain on sale of Connecticut state and local government bonds
9
00
10. Refunds of Connecticut income tax
10
00
11. Other (Specify) __________________________________________________________________
11
00
12. Total subtractions: Add Lines 7 through 11.
12
13. Connecticut fi duciary adjustment: Subtract Line 12 from Line 6. This amount may be positive or
00
negative. Enter on Schedule CT-1041B, Part 1, Line f, Column 5.
13
Resident estates or full year resident trusts, except for those that meet the Quick-File
Requirements, must attach Schedule CT-1041C and, if applicable, Schedule CT-1041FA.
Questions
A. If the trust is an inter vivos trust, enter name, address, and Social Security Number of grantor:
_______________________________________________________________________________________________________
B. If you checked Part-year resident trust on the front of this return, enter the date on which the trust became irrevocable:
_______________________________________________________________________________________________________
C. Does the trust or estate have an interest in real property or tangible personal property located in Connecticut?
Yes
No
Completed CT-1041 schedules must be attached to the back of Form CT-1041 in the following order unless the trust or estate meets the
Quick-File Requirements.
1. Schedule CT-1041B
2. Schedule CT-1041C
3. Schedule CT-1041FA
4. Form CT-1041 Schedule I
Also attach the following, if applicable:
1. Schedule CT-IT Credit;
2. Worksheet B, Worksheet for Schedule CT-IT Credit;
3. Forms W-2, W-2G, 1099, and Schedule CT K-1 if Connecticut income tax was withheld or the tax withheld will be disallowed; and
4. Copies of all income tax returns fi led with qualifying jurisdictions or the credit for income taxes paid to a qualifying jurisdiction will be
disallowed.
Amended return: Attach a statement explaining the reason for fi ling an amended return.
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.
Signature of fi duciary or offi cer representing fi duciary
Date
Telephone number
(
)
Sign
Email address of the fi duciary or offi cer representing fi duciary
Here
Paid preparer’s signature
Preparer’s Tax Identifi cation Number (PTIN) or SSN
Keep a
copy of
this return
Firm’s name and address
FEIN
for your
records.
Telephone number
(
)
Form CT-1041 Back (Rev. 12/13)
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