Connecticut Resident Income Tax Return Form

If a resident of the State of Colorado who is single wants to report his income tax to the state, he/she has to complete and send this form.

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For a faster refund, fi le your return electronically at www.ct.gov/DRS and choose direct deposit.	
Due date:  April 15, 2013  -  Attach a copy of all applicable schedules and forms to this return.	
1.  Federal adjusted gross income from federal Form 1040, Line 37;
Form 1040A, Line 21; or Form 1040EZ, Line 4  1.
2.  Additions to federal adjusted gross income from Schedule 1, Line 39  2.
3.  Add Line 1 and Line 2.  3.
4.  Subtractions from federal adjusted gross income from Schedule 1, Line 50  4.
5. Connecticut adjusted gross income: Subtract Line 4 from Line 3.  5.
6.  Income tax from tax tables or Tax Calculation Schedule: See instructions, Page 18.  6.
7. Credit for income taxes paid to qualifying jurisdictions from Schedule 2, Line 59  7.
8.  Subtract Line 7 from Line 6. If Line 7 is greater than Line 6, enter “0.”  8.
9.  Connecticut alternative minimum tax from Form CT-6251  9.
10.  Add Line 8 and Line 9.  10.
11.  Credit for property taxes paid on your primary residence, motor vehicle, or both:
Complete and attach Schedule 3 on Page 4 or your credit will be disallowed.   11.
12.  Subtract Line 11 from Line 10. If less than zero, enter “0.”  12.
13.  Total allowable credits from Schedule CT-IT Credit, Part I, Line 11  13.
14. Connecticut income tax: Subtract Line 13 from Line 12. If less than zero, enter “0.”  14.
15.  Individual use tax from Schedule 4, Line 69: If no tax is due, enter “0.”  15.
16.  Add Line 14 and Line 15.  16. Whole Dollars Only	
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Form CT-1040Connecticut Resident Income Tax Return	2012
CT-1040	
For DRS 
Use Only	20	
2	
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For the year January 1 - December 31, 2012, or other taxable year beginning: _________________ , 2012 and ending:  __________________, ______ .	
Complete return in blue or black ink only.Taxpayers must sign declaration on reverse side.	
Clip check here. Do not staple.
Do not send W-2 or 1099 forms.
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Filing separately for 
federal and ConnecticutFiling separately for 
Connecticut only	
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Filing Status - Check only one box.	
Single	Filing jointly 
for federal and 
Connecticut	Filing jointly for 
Connecticut 
only	Head of 
household	Qualifying widow(er)
with dependent child
Enter spouse’s name here and SSN below.	1	
MI
Last name (If two last names, insert a space between names.)
Last name (If two last names, insert a space between names.)Suffi x (Jr./Sr.)
Suffi x (Jr./Sr.) Your fi rst name
Mailing address (number and street, apartment number, suite number, PO Box)MI
If joint return, spouse’s fi rst name	
Your Social Security Number	
-
-	Check if 
deceased	--	Check if 
deceased	Spouse Social Security Number
City, town, or post offi ce	
 (If town is two words, leave a space between the words.)	State ZIP code	
-	
Print your SSN, name, mailing 
address, and city or town here.
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Enter city or town of residence if different from above.   ZIP code	
Form CT-8379
Form CT-1040CRC Check here if you are fi ling these forms. Attach the form(s) to the front of the return. Check if you fi led Form CT-2210 
and checked any boxes on Part 1.

Your Social Security Number		2012 Form CT-1040 - Page 2 of 4	
Column C
Connecticut income tax withheld
W-2 and 1099 
Information
Only enter 
information 
from your W-2  
and 1099 forms 
if Connecticut 
income tax 
was withheld.	
17.  Enter amount from Line 16.  17.	
3	
  18h.  Additional CT withholding from Supplemental Schedule CT-1040WH 18h.
18. Total Connecticut income tax withheld: Add amounts in Column C and enter here.
 You must complete Columns A, B, and C or your withholding will be disallowed.  18.
19. All 2012 estimated tax payments and any overpayments applied from a prior year  19.	
20.	  Payments made with Form CT-1040 EXT (Request for extension of time to fi le)  20.	
20a. 	Connecticut earned income tax credit: From Schedule CT-EITC, Line 16.  20a.
21. Total payments: Add Lines 18, 19, 20, and 20a.  21.
22.  Overpayment: If Line 21 is more than Line 17, subtract Line 17 from Line 21.  22.
23.  Amount of Line 22 overpayment you want applied to your 2013 estimated tax 23.
24.  Total contributions of refund to designated charities from Schedule 5, Line 70  24.
25. Refund: Subtract Lines 23 and 24 from Line 22. For faster refund, use direct
deposit by completing Lines 25a, 25b, and 25c. If you do not elect direct deposit,
in most cases, the refund will be issued by debit card. 25.	
4	
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Column B
Connecticut wages, tips, etc.	
6	
Column A
Employer’s federal ID No. from Box b of W-2, 
or payer’s federal ID No. from Form 1099	
26.  Tax due: If Line 17 is more than Line 21, subtract Line 21 from Line 17.  26.
27.  If late: Enter penalty. Multiply Line 26 by 10% (.10).  27.
28.  If late: Enter interest. Multiply Line 26 by number of months or fraction of a month
late, then by 1% (.01).  28.
29.  Interest on underpayment of estimated tax from Form CT-2210:  29.
See instructions, Page 21.
30. Total amount due: Add Lines 26 through 29. 30.	5	
18a.
18b.
18c.
18d.
18e.
18f.
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25a. 	Checking	 	25b. Routing 25c. Account	 	Savings	           number   number
25d. Will this refund go to a bank account outside the U.S.?    	
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Complete applicable schedules on Pages 3 and 4 and send all four pages of the return to DRS.	
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, or 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.	
Sign Here - Keep a copy for your records.	
Your signature Date  Daytime telephone number
Your email address
Spouse’s signature (if joint return)  Date  Daytime telephone number 
Paid preparer’s signature  Date   Telephone number  Preparer’s SSN or PTIN
Firm’s name, address, and ZIP code        FEIN	
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Designee’s name	 	Telephone number	 	Personal identifi cation number 	(PIN) Third Party Designee - Complete the following to authorize DRS to contact another person about this return.	
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(       )	
(       )(       )

31. Interest on state and local government obligations other than Connecticut  31.
32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal
government obligations  32.
33. Reserved for future use. 33.
34. Taxable amount of lump-sum distributions from qualifi ed plans not included in federal
adjusted gross income  34.
35. Benefi ciary’s share of Connecticut fi duciary adjustment: Enter only if greater than zero.  35.
36. Loss on sale of Connecticut state and local government bonds  36.
37. Domestic production activity deduction from federal Form 1040, Line 35  37.
38. Other - specify     ________________________________________________________  38.
39. Total additions: Add Lines 31 through 38.  Enter here and on Line 2.  39.
40. Interest on U.S. government obligations  40.
41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations  41.
42. Social Security benefi t adjustment: See Social Security Benefi t Adjustment Worksheet, Page 24.  42.
43. Refunds of state and local income taxes  43.
44. Tier 1 and Tier 2 railroad retirement benefi ts and supplemental annuities  44.
45. 50% of military retirement pay  45.
46. Benefi ciary’s share of Connecticut fi duciary adjustment: Enter only if less than zero.  46.
47. Gain on sale of Connecticut state and local government bonds  47.
48. Connecticut Higher Education Trust (CHET) contributions        48.
  Enter CHET account number:	
Do not add spaces or dashes.	    
49. Other - specify: Do not include out of state income.    ___________________________  49.
50. Total subtractions: Add Lines 40 through 49.  Enter here and on Line 4.  50.	
51. Modifi ed Connecticut adjusted gross income    51.
See instructions, Page 28. 
52. Enter qualifying jurisdiction’s name and two-letter
code: See instructions, Page 28.  52.
53. Non-Connecticut income included on Line 51 and
reported on a qualifying jurisdiction’s income tax
return: Complete Schedule 2 Worksheet, Page 28. 53. 
54. Divide Line 53 by Line 51. May not exceed 1.0000 54.
55. Income tax liability: Subtract Line 11 from Line 6.  55.
56. Multiply Line 54 by Line 55.  56.
57. Income tax paid to a qualifying jurisdiction 
See instructions, Page 29.  57.
58. Enter the lesser of Line 56 or Line 57.  58.
59. Total credit: Add Line 58, all columns.  Enter here and on Line 7.  59.
Schedule 2 - Credit for Income Taxes Paid to Qualifying Jurisdictions
You must attach a copy of your return fi led with the qualifying jurisdiction(s) or your credit will be disallowed.	
Complete applicable schedules on Page 4 and send all four pages of the return to DRS.	
Schedule 1 - Modifi cations to Federal Adjusted Gross Income 	Enter all items as positive numbers.	
See instructions, Page 22.	 
2012 Form CT-1040 - Page 3 of 4	
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Your Social
Security Number		--	
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Column B	 Name Code	Column A	 Name Code	
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For refunds and all other tax forms without payment:
 Department of Revenue Services
  PO Box 2976
  Hartford CT 06104-2976	
Make your check payable to Commissioner of Revenue Services
To ensure proper posting, write your SSN(s) (optional) and “2012 Form CT-1040” on your check.	
For all tax forms with payment:
 Department of Revenue Services
  PO Box 2977
  Hartford CT 06104-2977	
2012 Form CT-1040 - Page 4 of 4	Your Social
Security Number		--	
Schedule 4 - Individual Use Tax - Do you owe use tax? 	See instructions, Page 31.	
Complete the Connecticut Individual Use Tax Worksheet on Page 32 to calculate your use tax liability.
69a. Total use tax due at 1%: From 	Connecticut Individual Use Tax Worksheet, 	Section A, Column 7.  69a.
69b. Total use tax due at 6.35%: From 	
Connecticut Individual Use Tax Worksheet, 	Section B, Column 7 69b.
69c. Total use tax due at 7%: From 	
Connecticut Individual Use Tax Worksheet, 	Section C, Column 7  69c.
69. Individual use tax: Add Lines 69a through 69c. If no use tax is due, enter “0.”
Enter here and on Line 15.      	
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70a. AIDS  Research  70a.
70b. Organ  Transplant  70b.
70c. Endangered Species/Wildlife   70c.
70d. Breast Cancer Research  70d.
70e. Safety Net Services  70e.
70f.  Military Family Relief Fund  70f.
70. Total Contributions: Add Lines 70a through 70f. Enter amount here and on Line 24.  70.	
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Schedule 5 - Contributions to Designated Charities 	- See more information on Page 6.
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Qualifying Property
Name of Connecticut Tax 
Town or District
Description of Property
If primary residence, enter 
street address.
If motor vehicle, enter year, 
make, and model.
Date(s) PaidPrimary Residence Auto 1Auto 2 	(joint returns or qualifying widow(er) only)	
Schedule 3 - Property Tax Credit  	See instructions, Page 29.	
_ _ 	/_ _ 	/ 2012	
_ _ 	/_ _ 	/ 2012	
_ _ 	/_ _ 	/ 2012	
_ _ 	/_ _ 	/ 2012	
_ _ 	/_ _ 	/ 2012	
_ _ 	/_ _ 	/ 2012	
 Amount Paid 60. 61. 62.
63. Total property tax paid: Add Lines 60, 61, and 62.  63.
64. Maximum property tax credit allowed 64.
65. Enter the lesser of Line 63 or Line 64.  65.
66. Enter the decimal amount for your fi ling status and Connecticut AGI from the Property Tax 
Credit Table exactly as it appears on Page 30. If zero, enter the amount from Line 65 on Line 68.  66.
67. Multiply Line 65 by Line 66. 67.
68. Subtract Line 67 from Line 65. Enter here and on Line 11.
Attach Schedule 3 to your return or your credit will be disallowed.  68.	
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Use the correct mailing address for returns requesting a refund or with a payment.	
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.