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Connecticut Free Printable CT-12-717B,  Change of Resident Status - Sepcial Accruals Other Acceptable Security Form for 2018 Connecticut Change of Resident Status - Special Accruals Other Acceptable Security Form

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Change of Resident Status - Special Accruals Other Acceptable Security Form
CT-12-717B, Change of Resident Status - Sepcial Accruals Other Acceptable Security Form

Department of Revenue Services State of Connecticut 450 Columbus Blvd Ste 1 Hartford CT 06103-1837 Form CT-12-717B Change of Resident Status - Special Accruals Other Acceptable Security Form (Rev. 03/17) Social Security Number Spouse’s Social Security Number Complete this agreement and forward it by registered mail with the security described below to: Department of Revenue Services, Attention: Director, Operations Division, 450 Columbus Blvd Ste 1, Hartford CT 06103-1837. If filing a joint return, include both names. Enter your Social Security Number(s) above. When filing Form CT-1040NR/PY or Form CT-1041 for the taxable year in which the change of resident status occurred, attach a copy of this form to the return. Whereas, I (we), ________________________________________________________________________________________________ (address as shown on return) , of _____________________________________________________________________________________________ , have changed my (our) resident status for Connecticut income tax purposes from that of a resident individual(s) to that of a nonresident individual(s) on (date) ____________ , and Whereas, I (we) elect under Conn. Gen. Stat. §12-717(c)(4) to file my (our) Connecticut income tax return for the period prior to my (our) change of residence on the cash receipts basis, and Whereas, the tax as determined under Conn. Gen. Stat. §§12-700(c)(2) and 12-717(c)(1) for the portion of the taxable year prior to my (our) change of residence would have been increased by the amount of $ _________________ if such election had not been made, and Whereas, I (we) hereby deposit with you the following described security: I. Bank passbooks and certificates of deposit: Bank/Financial Institution Amount Maturity Date (If certificate of deposit) Attached and made part of this agreement is a letter prepared on the letterhead of the bank/financial institution and signed by an officer thereof: 1. Identifying the passbooks or certificates of deposit by account number and confirming that withdrawal of principal from the passbook or certificate of deposit will not be permitted without written consent from the Connecticut Department of Revenue Services (DRS); and 2. Stating that any right of setoff which the bank/financial institution may possess against the taxpayer(s) resulting from a defaulted obligation of the taxpayer(s) shall be subordinate to the interest of DRS in the passbook or certificate of deposit offered as collateral. II. Standby letter of credit: Issuer or Confirming Bank Amount Expiration Date Attached and made part of this agreement is the irrevocable standby letter of credit made payable to DRS. III. Form W-2G, Certain Gambling Winnings: Attached and made part of this agreement is a copy of the completed federal Form W-2G, Certain Gambling Winnings, showing Connecticut income tax was withheld from my (our) Connecticut lottery payments. Now, therefore, I (we) agree that (1) I (we) will include in my (our) Connecticut income tax returns in subsequent taxable years (or periods) all income and gain accrued prior to my (our) change of residence as if I (we) had not changed my (our) resident status and will pay the tax thereon when due; (2) the period of limitation within which tax may be assessed, set forth in Conn. Gen. Stat. §12-733, is hereby extended as provided by subsection (f) of such section, and I (we) hereby agree that the tax due may be assessed for any taxable year (or periods) at any time within three years after the tax return relating to the last taxable year during which income or gain accruing prior to my (our) change of residence is actually received has been filed; and (3) if the DRS determines (a) that I (we) have failed to include in my (our) Connecticut income tax return for any taxable year (or period) any item of income or gain required to be included therein under the terms of this agreement or to pay any tax required to be paid, or (b) that the security filed herewith has or will become inadequate to properly secure payment of the tax, the full amount of income which is accruable under Conn. Gen. Stat. §12-717(c)(1) shall be accrued to the portion of the taxable year prior to the change of residence and the additional tax for the period, as recomputed, shall become due immediately. If the tax is not paid within 30 days after notice of a determination described in (a) above has been mailed to me (us) by ordinary mail, or if the security which has been determined, as described in (b) above, to be inadequate to secure payment of the tax is not replaced with adequate security acceptable to DRS within 30 days after notice of a determination has been mailed to me (us) by ordinary mail, DRS may sell, assign, transfer, withdraw, or otherwise dispose of said security and apply the proceeds to any unpaid portion of the tax deferred by reason of the election and any interest and penalties due thereon. The balance of such proceeds, if any, shall be paid to me (us). The security described above is deposited with the understanding that: (1) in case no disposition is made thereof under the terms of this agreement, such security will be returned to me (us) at such time as DRS determines it is no longer needed as security by reason of the full or partial payment of the tax deferred as a result of the election under Conn. Gen. Stat. §12-717(c)(4); and (2) any interest accruing on said security shall belong to me (us). Signature of taxpayer Spouse’s signature (If joint return) Form CT-12-717B Back (Rev. 03/17) Date
Extracted from PDF file 2017-connecticut-form-ct-12-717b.pdf, last modified March 2017

More about the Connecticut Form CT-12-717B Individual Income Tax TY 2017

We last updated the Change of Resident Status - Special Accruals Other Acceptable Security Form in January 2018, so this is the latest version of Form CT-12-717B, fully updated for tax year 2017. You can download or print current or past-year PDFs of Form CT-12-717B directly from TaxFormFinder. You can print other Connecticut tax forms here.

Other Connecticut Individual Income Tax Forms:

TaxFormFinder has an additional 85 Connecticut income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form CT-1040 Connecticut Resident Income Tax Return
Tax Instruction Booklet Form CT-1040 Instruction Booklet
Form CT-1040NR-PY Nonresident/Part-Year Resident Tax Return
CT-1040NR/PY Instructions Tax Instruction Booklet: CT-1040NR/PY
Form CT-1040X Amended Income Tax Return for Individuals

Download all CT tax forms View all 86 Connecticut Income Tax Forms


Form Sources:

Connecticut usually releases forms for the current tax year between January and April. We last updated Connecticut Form CT-12-717B from the Department of Revenue Services in January 2018.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Connecticut Form CT-12-717B

We have a total of seven past-year versions of Form CT-12-717B in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2017 Form CT-12-717B

CT-12-717B, Change of Resident Status - Sepcial Accruals Other Acceptable Security Form

2016 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form

Change of Resident Status - Special Accruals Other Acceptable Security Form 2015 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form

Change of Resident Status - Special Accruals Other Acceptable Security Form 2014 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form

Change of Resident Status - Special Accruals Other Acceptable Security Form 2013 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form

Change of Resident Status - Special Accruals Other Acceptable Security Form 2012 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form

Change of Resident Status - Special Accruals Other Acceptable Security Form 2011 Form CT-12-717B

Form CT-12-717B, Change of Resident Status - Special Accruals Other Acceptable Security Form


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