Connecticut Part-Year Resident Income Allocation Worksheet

Part-Year Resident Income Allocation Worksheet
Form CT-1040 AW
2023

Schedule CT-1040AW

Department of Revenue Services
State of Connecticut

Part-Year Resident Income Allocation

(Rev. 12/23)

Part-year residents must complete this schedule before completing Schedule CT-SI and attach it to Form CT-1040NR/PY. Do not use staples. Complete in blue or black ink only.
Please note that each form is year specific. To prevent any delay in processing your return, the correct year’s form must be submitted to the Department of Revenue Services (DRS).
Your first name and middle initial	

Last name

If joint return, spouse’s first name and middle initial	

Last name

Part 1 – Adjusted Gross Income

Federal Income
as Modified
See instructions.

Column A

Your Social Security Number
••
••
••
••
Spouse’s Social Security Number
••
••
••
••

__ __

__ __ __ __

__ __ __

__ __

__ __ __ __

Connecticut
Nonresident Period

Connecticut
Resident Period

Column B

Income from
federal return

__ __ __

Income from Column A
for this period

Column C

Income from Column A
for this period

Column D

Income from Column C
from Connecticut sources

	 1.	 Wages, salaries, tips, etc......................................... 	1.

	 2.	 Taxable interest........................................................ 	 2.
	 3.	 Ordinary dividends................................................... 	 3.
	 4.	 Alimony received..................................................... 	4.
	 5.	 Business income or (loss)........................................ 	5.
	 6.	 Capital gain or (loss)................................................	 6.
	 7.	 Other gains or (losses)............................................ 	7.
	 8.	 Taxable amount of IRA distributions........................	 8.

	 9.	 Taxable amounts of pension and annuities.............. 	9.
	10.	 Rental real estate, royalties, partnerships,
		S corporations, trusts, etc........................................	10.
	11.	 Farm income or (loss).............................................. 	 11.
	12.	 Unemployment compensation.................................	 12.
	13.	 Taxable amount of social security benefits..............	 13.
	14.	 Other income: See instructions. ..............................	14.
15.	
	15.	 Add Lines 1 through 14. ....................................... 	

Part 2 – Adjustments to Income

00	

	

00	

	

00	

	

	16.	 Educator expenses..................................................	 16.
	17.	 Certain business expenses of reservists, performing
		 artists, and fee-basis government officials...............	 17.
	18.	 Health savings account deduction...........................	 18.
	19.	 Moving expenses for members of the armed forces	 19.
	20.	 Deductible part of self-employment tax...................	 20.
	21.	 Self-employed SEP, SIMPLE, and qualified plans...	 21.
	22.	 Self-employed health insurance deduction..............	 22.
	23.	 Penalty on early withdrawal of savings....................	 23.
	24.	 Alimony paid............................................................	 24.
	25.	 IRA deduction..........................................................	 25.
	26.	 Student loan interest deduction...............................	 26.
	27.	 Archer MSA deduction.............................................	 27.
	28.	 Other adjustments...................................................	 28.
	29.	 Total adjustments: Add Lines 16 through 28. ..........	 29.
30.	
	30.	 Subtract Line 29 from Line 15. ............................. 	
00	 	
00	 	
00	 	
Line 30, Column A, must equal the amount on Form CT‑1040NR/PY, Line 5.
Add Columns B and D for each line and enter the totals on Lines 1 through 30 on Schedule CT‑SI.

00

00

Part 3 – Part‑Year Resident Information
Moved Into Connecticut
1.	Date you moved into Connecticut 	/	 /	 and state of prior residence:
2.	 Date your spouse moved into Connecticut 	/	 /	 and state of prior residence:

Moved Out of Connecticut
1.	 Date you moved out of Connecticut 	/	/	 and state of new residence:
2.	 Date your spouse moved out of Connecticut 	/	 /	 and state of new residence:

Income From Connecticut Sources During Nonresident Period
1.	Did you receive income from Connecticut sources during your nonresident period?.....................................................	
Yes	
2.	 Did your spouse receive income from Connecticut sources during his or her nonresident period?.............................. Yes	

Visit us at portal.ct.gov/DRS for more information.

	No
	No