Form Ct-1040 - Connecticut Resident Income Tax Return

Your Social

Form CT-1040 - Page 2

Security Number

17. Enter amount from Line 16.

17.

Column B

Column C

Column A

Connecticut Income Tax Withheld

Employer’s federal ID No. from Box b of W-2,

Connecticut Wages, Tips, etc.

or Payer’s federal ID No. from W-2G, or 1099

–

18a.

W-2, W-2G,

and 1099

–

18b.

Information

(Only enter

–

18c.

information

from your W-2,

–

W-2G, and

18d.

1099 forms if

–

Connecticut

18e.

income tax

–

was withheld.)

18f.

–

18g.

18h. Enter amount from Supplemental Schedule CT-1040WH, Line 3.

18h.

18. Total Connecticut Income Tax Withheld (Add amounts in Column C and enter here.) 18.

You must complete Columns A, B, and C or your withholding will be disallowed.

19. All 2006 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 file)

20.

21. Total Payments (Add Lines 18, 19, and 20.)

21.

22. Overpayment (If Line 21 is more than Line 17, subtract Line 17 from Line 21.)

22.

23. Amount of Line 22 you want applied to your 2007 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.

25.

25a.Type:

25b. Routing

25c. Account

checking

Number

savings

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

29.

(From Form CT-2210, see instructions, Page 17.)

30.

30. Total Amount Due (Add Lines 26 through 29.)

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

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

FEIN

Third Party Designee - Complete the following if you wish to authorize DRS to contact another person about this return.

Designee’s Name

Telephone Number

Personal Identification Number (PIN)

Complete applicable schedules on Form CT-1040 - Pages 3 and 4.

Form Ct-1040 - Connecticut Resident Income Tax Return - 2006 Page 2

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