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Form CT-1040NR/PY

2011

For DRS

2 0

Connecticut Nonresident and Part-Year

Use Only

CT-1040NR/PY

Resident Income Tax Return

Taxpayers must sign declaration on reverse side.

Complete return in blue or black ink only.

For the year January 1 - December 31, 2011, or other taxable year beginning: _________________ , 2011 and ending: __________________, ______ .

Filing Status - Check only one box.

Filing separately for

federal and Connecticut

Connecticut only

Filing jointly

Head of

Qualifying widow(er)

Filing jointly for

Single

for federal and

household

with dependent child

Connecticut



Connecticut

only

Enter spouse’s name here and SSN below.

Your Social Security Number

Spouse Social Security Number

Check if

deceased

Your ﬁ rst name

Last name (If two last names, insert a space between names.)

Sufﬁ x (Jr./Sr.)

If joint return, spouse’s ﬁ rst name

Last name (If two last names, insert a space between names.)

Sufﬁ x (Jr./Sr.)

Mailing address (number and street, apartment number, suite number, PO Box)

2011 resident status

Nonresident

Part-year resident

State

ZIP code

City, town, or post ofﬁ ce

(If town is two words, leave a space between the words.)

Enter city or town of residence if different from above.

ZIP code

Check if you ﬁ led Form CT-2210

Check here if you are ﬁ ling these forms. Attach the form(s) to the front of the return.

and checked any boxes on Part 1.

Form CT-8379

Form CT-1040CRC

Whole Dollars Only

1. Federal adjusted gross income from federal Form 1040, Line 37;

Form 1040A, Line 21; or Form 1040EZ, Line 4

2. Additions to federal adjusted gross income from Schedule 1, Line 41

3. Add Line 1 and Line 2.

4. Subtractions from federal adjusted gross income from Schedule 1, Line 52

5. Connecticut adjusted gross income: Subtract Line 4 from Line 3.

6. Income from Connecticut sources from Schedule CT-SI, Line 30

7. Enter the greater of Line 5 or Line 6. If zero or less, go to Line 12 and enter “0.” 7.

8. Income tax on the amount on Line 7 from tax tables or Tax Calculation Schedule:

See instructions, Page 17.

9. Divide Line 6 by Line 5. If Line 6 is equal to or greater than Line 5, enter 1.0000.

10. Multiply Line 9 by Line 8.

10.

11. Credit for income taxes paid to qualifying jurisdictions during resident portion

of taxable year — part-year residents only (from Schedule 2, Line 61)

11.

12. Subtract Line 11 from Line 10. If Line 11 is greater than Line 10, enter “0.”

12.

13. Connecticut alternative minimum tax from Form CT-6251

13.

14. Add Line 12 and Line 13.

14.

15. Total allowable credits from Schedule CT-IT Credit, Part I, Line 11

15.

16. Connecticut income tax: Subtract Line 15 from Line 14. If less than zero, enter “0.” 16.

17. Individual use tax from Schedule 3, Line 62: If no tax is due, enter “0.”

17.

18. Add Line 16 and Line 17.

18.

Due date: April 15, 2012 - Attach a copy of all applicable schedules and forms to this return.

For a faster refund, ﬁ le your return electronically at and choose direct deposit.

Form Ct-1040nr/py - Connecticut Nonresident And Part-Year Resident Income Tax Return - 2011

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