Form Ct-1040ez - Connecticut Resident Ez Income Tax Return - 2008 Page 2
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2
3Form CT-1040EZ - Page 2 of 3
Your Social
-
-
Security Number
00
.
9. Enter amount from Line 8.
9.
,
Column B
Column C
Column A
3
Employer’s federal ID No. from Box b of W-2
Connecticut wages, tips, etc.
or payer’s federal ID No. from Form 1099
Connecticut income tax withheld
.
–
00
.
00
10a.
10a.
,
W-2 and 1099
Information
.
–
00
00
.
10b.
10b.
,
Only enter
information
.
–
00
00
.
from your W-2
10c.
10c.
,
and 1099 forms
.
–
00
00
.
if Connecticut
10d.
,
10d.
income tax
.
–
00
was withheld.
.
00
10e.
10e.
,
.
–
00
.
00
10f.
10f.
,
.
–
00
00
.
,
10g.
10g.
00
.
,
10h.
Enter amount from Supplemental Schedule CT-1040WH, Line 3.
10h.
.
00
,
10. Total Connecticut income tax withheld: Add amounts in Column C and enter here.
10.
You must complete Columns A, B, and C or your withholding will be disallowed.
00
.
,
11. All 2008 estimated tax payments and any overpayments applied from a prior year
11.
00
.
,
12. Payments made with Form CT-1040 EXT (Request for extension of time to fi le)
12.
00
.
,
13. Total payments: Add Lines 10, 11, and 12.
13.
4
00
.
,
14. Overpayment: If Line 13 is more than Line 9, subtract Line 9 from Line 13.
14.
00
.
,
15. Amount of Line 14 you want applied to your 2009 estimated tax
15.
00
.
,
16. Total contributions of refund to designated charities from Schedule 3EZ, Line 29
16.
17. Refund: Subtract Lines 15 and 16 from Line 14.
.
00
,
For faster refund, use Direct Deposit by completing Lines 17a, 17b, and 17c.
17.
17a. Type:
17b. Routing
17c. Account
Checking
Number
Number
Savings
5
00
.
,
18. Total amount due: If Line 9 is more than Line 13, subtract Line 13 from Line 9.
18.
Declaration: I declare under penalty of law that I have examined this return (including any accompanying
6
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.
Your signature
Date
Daytime telephone number
(
)
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
Federal Employer Identifi cation Number
Third Party Designee - Complete the following to authorize DRS to contact another person about this return.
Designee’s name
Telephone number
Personal identifi cation number (PIN)
Complete applicable schedules on Form CT-1040EZ, Page 3, and send all three pages of the return to DRS.
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