Form Ct-1040ez - Connecticut Resident Ez Income Tax Return

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

For the year January 1 - December 31, 2000, or other taxable year

beginning _____________, 2000,

ending _____________, ______.

Your First Name and Middle Initial

Last Name

Social Security Number

__ __ __

__ __

__ __ __ __

• •

Use the

If a JOINT Return, Spouse’s First Name and Middle Initial

Spouse’s Social Security Number

Last Name

DRS label

__ __ __

__ __

__ __ __ __

• •

located on

• •

cover.

IMPORTANT!

Home Address (number and street)

PO Box

Apt. No.

Otherwise,

You MUST enter your SSN(s) above.

print or type.

(See

City, Town or Post Office

State

ZIP Code

DEPARTMENT USE ONLY

instructions,

Page 12)

TELEFILING OR ELECTRONIC FILING MAY SPEED YOUR REFUND

You may file Form CT-1040EZ if you meet ALL of the following conditions:

(See instructions, Page 7)

A. You were a resident of Connecticut for the entire taxable year; and

B. You have no modifications to Federal Adjusted Gross Income for Connecticut income tax purposes; or your only modification is a

federally taxable refund of state and local income taxes; and

C. You are not claiming credit for income taxes paid to a qualifying jurisdiction; and

D. You do not have a federal alternative minimum tax liability, and you are not claiming an adjusted net Connecticut minimum tax credit.

Check here if you do not want forms sent to you next year. Checking this box does not relieve you of your responsibility to file.

NOTE: Your filing status must be the same as your federal income tax filing status for this year. (See instructions, Page 12)

Single

__ __ __

__ __

__ __ __ __

Married filing joint return or Qualifying widow(er) with dependent child

• •

Check only

Married filing SEPARATE return __________________________________________

___________________________________________

one box.

Spouse’s full name

Spouse’s Social Security Number

Head of household (with qualifying person)

1. Federal Adjusted Gross Income (from federal Form 1040, Line 33; Form 1040A, Line 19;

Form 1040EZ, Line 4; or federal TeleFile Tax Record, Line

)

2. Refunds of state and local income taxes (from federal Form 1040, Line 10; see instructions, Page 12 )

(Subtract Line 2 from Line 1)

4. Income Tax: From Tax Tables or Tax Calculation Schedule (See instructions, Page 12)

5. Credit for property taxes paid on your primary residence and/or motor vehicle. (You must complete

Schedule 2 EZ on reverse and enter the amount from Line 26 here. See instructions, Page 13.)

(Subtract Line 5 from Line 4. If less than zero, enter “0.”)

(Complete Schedule 1 EZ on reverse) Enter the amount from Line 18 here.

You must enter “0” on this line if no use tax is due. (See instructions, Page 13)

(Add Line 6 and Line 7)

9. Connecticut tax withheld (Attach all W-2s and certain 1099s; see instructions, Page 13)

10. All 2000 estimated tax payments and any overpayments applied from a prior year

11. Payments made with Form CT-1040 EXT (request for extension of time to file)

12.

(Add Lines 9, 10, and 11)

13. If Line 12 is greater than Line 8, enter amount overpaid. (Subtract Line 8 from Line 12)

14. Amount of Line 13 you want applied to your 2001 estimated tax

15. Amount of Line 13 you want to contribute to: (See instructions, Page 14)

AIDS Research

_____ $ 2

_____ $ 5

_____ $ 1 5

other ______ . 0 0

Organ Transplant

_____ $ 2

_____ $ 5

_____ $ 1 5

other ______ . 0 0

Endangered Species/Wildlife

_____ $ 2

_____ $ 5

_____ $ 1 5

other ______ . 0 0

Breast Cancer Research

_____ $ 2

_____ $ 5

_____ $ 1 5

other ______ . 0 0

Safety Net Services

_____ $ 2

_____ $ 5

_____ $ 1 5

other ______ . 0 0

Total Contributions

16. Amount of Line 13 you want refunded to you

(Subtract Line 14 and Line 15 from Line 13)

17. If Line 8 is greater than Line 12, enter the amount of tax you owe.

(Subtract Line 12 from Line 8. See instructions, Page 14)

Use envelope provided, with correct mailing label, or mail to:

Make your check or money order payable to:

COMMISSIONER OF REVENUE SERVICES

For refund request or no tax due –

For payment –

Write your Social Security Number(s) and

Department of Revenue Services

“2000 Form CT-1040EZ” on your check or

PO Box 150420

PO Box 150440

money order.

Hartford CT 06115-0420

Hartford CT 06115-0440

Taxpayers must sign declaration on reverse — Due date: April 17, 2001 — Attach a copy of all applicable schedules and forms to this return.

Form Ct-1040ez - Connecticut Resident Ez Income Tax Return - 2000

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