Form Ct-1040nr/py - Connecticut Nonresident And Part-Year Resident Income Tax Return - 2011 Page 4

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2011 Form CT-1040NR/PY - Page 4 of 4
Your Social
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Security Number
Schedule 3 - Individual Use Tax - Do you owe use tax?
See instructions, Page 37.
Complete the Connecticut Individual Use Tax Worksheet on Page 38 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.
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62b. Total use tax due at 6.35%: From Connecticut Individual Use Tax Worksheet, Section B, Column 7 62b.
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62c. Total use tax due at 7%: From Connecticut Individual Use Tax Worksheet, Section C, Column 7
62c.
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62d. Total use tax due at 6%: From Connecticut Individual Use Tax Worksheet, Section D, Column 7
62d.
62. Individual use tax: Add Lines 62a through 62d. If no use tax is due, enter “0.”
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Enter here and on Line 17.
62.
Schedule 4 - Contributions to Designated Charities
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63a. AIDS Research
63a.
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63b. Organ Transplant
63b.
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63c. Endangered Species/Wildlife
63c.
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63d. Breast Cancer Research
63d.
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63e. Safety Net Services
63e.
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63f. Military Family Relief Fund
63f.
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63.
Total contributions: Add Lines 63a through 63f, enter amount here and on Line 26.
63.
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If any amounts are entered on Page 3 or 4, attach sheets to Pages 1 and 2, and send all four pages of the return to DRS.
Use the correct mailing address for returns requesting a refund or with a payment.
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 “2011 Form CT-1040NR/PY” on your check.

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