Form Ct-1040x - Amended Connecticut Income Tax Return For Individuals - 2005 Page 2

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Schedule 1 Modifications to Federal Adjusted Gross Income

(Enter all amounts as positive numbers.)

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

32. Mutual fund exempt-interest dividends from non-Connecticut state or municipal government

Additions to

obligations other than Connecticut

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

Federal

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

33. Allocated for future use

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

Adjusted

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

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

Gross

gross income

Income

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

(See

instructions,

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

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

Page 3.)

37. Allocated for future use

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

38. Other - specify

39. Total Additions (Add Lines 31 through 38.) Enter here and on Line 2, Column C, on the

front of this form.

40. Interest on U.S. government obligations

41. Exempt dividends from certain qualifying mutual funds derived from U.S. government obligations

Subtractions

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

From

43. Refunds of state and local income taxes

Federal

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

Adjusted

Gross

45. Special depreciation allowance for qualified property placed in service during the preceding year(s)

Income

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

(See

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

instructions,

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

48. Allocated for future use

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

Page 3.)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7

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

50. Total Subtractions (Add Lines 40 through 49.) 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.)

51. Modified Connecticut Adjusted Gross Income

For each column, enter the following:

Column A

Column B

You must

Name

Code

Name

Code

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

attach a

copy of your

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

return filed

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

with the

54. Divide Line 53 by Line 51. (May not exceed 1.0000)

qualifying

55. Income tax liability (Subtract Line 15, Column C, from Line 10, Column C.) 55

jurisdiction(s)

56. Multiply Line 54 by Line 55.

or your credit

will be

57. Income tax paid to a qualifying jurisdiction

disallowed.

58. Enter the lesser of Line 56 or Line 57.

59. Total Credit (Add Line 58, all columns.)

Enter here and on Line 11, Column C, on the front of this form.

Withholding Schedule: Only enter information from your Schedule CT K-1, W-2, W-2G, and 1099 forms if Connecticut income tax was withheld.

Check if from

Column A: Employer ID Number

Column B: CT Wages, Tips, etc.

Column C: CT Income Tax Withheld

Schedule CT K-1

60a.

60b

60c

60d.

60e.

60f.

60g.

additional CT withholding from Supplemental Schedule CT-1040WH, Line 3.

60h. Enter

Total Connecticut income tax withheld

60.

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

Mail to:

Department of Revenue Services

To ensure

proper posting of your payment, write your Social Security Number(s)

PO Box 2978

(optional) and “2005 Form CT-1040X” on your check or money order. DRS may submit your check

Hartford CT 06104-2978

to your bank electronically.

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 fine of not more than $5,000, or imprisonment

for not more than five 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.

Your Signature

Date

Spouse’s Signature (if joint return)

Date

Sign

Here

Keep a

Paid Preparer’s Signature

Date

Telephone Number

Preparer’s SSN or PTIN

(