Ct Form 2019

Ct. gov/DRS and choose direct deposit. Your Social Security Number 2012 Form CT-1040NR/PY - Page 2 of 4 19. You must complete Columns A B and C or your withholding will be disallowed. 20. 21. All 2012 estimated tax payments and any overpayments applied from a prior year 22. Payments made with Form CT-1040 EXT Request for extension of time to file 23. Total payments Add Lines 20 21 and 22. Form CT-1040NR/PY For DRS Use Only Connecticut Nonresident and Part-Year 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 2012 or other taxable year beginning 2012 and ending. For refunds and all other tax forms without payment Department of Revenue Services PO Box 2968 Hartford CT 06104-2968 For all tax forms with payment Make your check payable to Commissioner of Revenue Services To ensure proper posting write your SSN s optional and 2012 Form CT-1040NR/PY on your check. State Part-year resident ZIP code Enter city or town of residence if different from above. Line references to federal Form 1040 series are based on information available from the Internal Revenue Service s website as of November 16 2012. Check if you filed Form CT-2210 and checked any boxes on Part 1. Clip check here. Do not staple. Do not send W-2 or 1099 forms. Form CT-1040NR/PY For DRS Use Only Connecticut Nonresident and Part-Year 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 2012 or other taxable year beginning 2012 and ending. Filing Status - Check only one box. Filing jointly for federal and Single only Filing separately for federal and Connecticut Head of household Qualifying widow er with dependent child Enter spouse s name here and SSN below. Print your SSN name mailing address and municipality here. Your Social Security Number - Spouse Social Security Number Check if deceased Your first name MI Last name If two last names insert a space between names. Suffix Jr. /Sr. If joint return spouse s first name Mailing address number and street apartment number suite number PO Box 2012 resident status Nonresident City town or post office If town is two words leave a space between the words. State Part-year resident ZIP code Enter city or town of residence if different from above. Line references to federal Form 1040 series are based on information available from the Internal Revenue Service s website as of November 16 2012. Check if you filed Form CT-2210 and checked any boxes on Part 1. Clip check here. Do not staple. Do not send W-2 or 1099 forms. Check here if you are filing these forms. Attach the form s to the front of the return* Form CT-8379 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.