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

SCHEDULE 1 - MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME

(See instructions, Page 2)

Additions To Federal Adjusted Gross Income - Enter All Amounts as Positive Numbers

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

32. Exempt-interest dividends from a mutual fund derived from state or municipal government obligations other

than Connecticut

33. Shareholder’s pro rata share of S corporation nonseparately computed loss

34. Taxable amount of lump sum distributions from qualified plans not included in federal adjusted gross income

35. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if greater than zero)

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

37. Other - specify

38. Total additions (Add Lines 31 through 37); Enter here and on Line 2, Column C, on the front of this form.

Subtractions From Federal Adjusted Gross Income - Enter All Amounts as Positive Numbers

39. Interest on United States government obligations

40. Exempt dividends from certain qualifying mutual funds derived from United States government obligations

41. Social Security benefit adjustment ( See Social Security Benefit Adjustment Worksheet, Page 4)

42. Refunds of state and local income taxes

43. Tier 1 and Tier 2 railroad retirement benefits and supplemental annuities

44. Shareholder’s pro rata share of S corporation nonseparately computed income

45. Beneficiary’s share of Connecticut fiduciary adjustment (Enter only if less than zero)

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

47. Other - specify (Do not include out-of-state income)

48. Total subtractions (Add Lines 39 through 47); Enter here and on Line 4, Column C, on the front of this form.

SCHEDULE 2 - CREDIT FOR INCOME TAXES PAID TO QUALIFYING JURISDICTIONS

(See instructions for Form CT-1040 or Form CT-1040NR/PY)

IMPORTANT: You must attach a copy of your return filed with the qualifying jurisdiction(s) or the credit will be disallowed.

MODIFIED CONNECTICUT ADJUSTED GROSS INCOME

49.

COLUMN A

COLUMN B

FOR EACH COLUMN, ENTER THE FOLLOWING:

Name

Code

Name

Code

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

51. Non-Connecticut income included on Line 49 and reported on a qualifying

jurisdiction’s income tax return (from Schedule 2 Worksheet )

52. Divide Line 51 by Line 49 (may not exceed 1.0000)

53. Income tax liability (Subtract Line 15, Column C, from Line 10, Column C)

54. Multiply Line 52 by Line 53

55. Income tax paid to a qualifying jurisdiction

56. Enter the lesser of Line 54 or Line 55

57. TOTAL CREDIT (Add Line 56, all columns) Enter here and on Line 11, Column C, on the front of this form.

SCHEDULE 3 (Connecticut Residents Only) - CREDIT FOR PROPERTY TAXES PAID ON YOUR PRIMARY RESIDENCE AND/OR

MOTOR VEHICLE - Failure to complete this schedule could result in the disallowance of this credit.

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

DESCRIPTION OF PROPERTY

LIST OR BILL

AMOUNT PAID

NAME OF

DATE PAID

QUALIFYING

NUMBER

(Enter amount of

CONNECTICUT

Enter description of property

(Enter date you

PROPERTY

(if available)

If primary residence, enter street address

paid property

TAX TOWN OR

property tax paid.)

If motor vehicle, enter year, make, and model

DISTRICT

tax.)

PRIMARY

RESIDENCE

AUTO 1

Married Filing

Jointly Only - AUTO 2

61. Total property tax paid (Add all amounts for Column E)

62. Maximum property tax credit allowed $500 (subject to limitation).

5 0 0

63. Enter the Lesser of Line 61 or Line 62. (If $100 or less, enter this amount on Line 65. If greater than $100, go to Line 64.) 63

64. Limitation - Enter the result from the Property Tax Credit Limitation Worksheet ( See Page 5 )

65. Subtract Line 64 from Line 63. Enter here and on Line 15, Column C, on the front of this form.

MAIL TO:

Department of Revenue Services

Make your check or money order payable to: Commissioner of Revenue Services

PO Box 2978

Write your Social Security Number(s) and “2000 Form CT-1040X” on your check or money order.

Hartford CT 06104-2978

DECLARATION: I declare under the penalties of false statement 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. The penalties for false statement are imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both. Declaration

of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your Signature

Date

Spouse’s Signature (if joint return)

Date

Sign

Here

Paid Preparer’s Signature

Date

Telephone Number

Preparer’s SSN or PTIN

Keep a