In navigating the complexities of tax requirements, residents of Connecticut might come across the CT-19IT form, a document that serves a unique and specific purpose within the state's tax filing process. This form is designated by the Department of Revenue Services—situated at 25 Sigourney St Ste 2, Hartford, Connecticut—and is intended for individuals who, during the taxable year of 2012, received benefits under Title 19. Title 19, in essence, relates to Medicaid and similar programs aimed at assisting with long-term care in either nursing or convalescent homes, or under the Connecticut Home Care Program for Elders. The CT-19IT form allows these individuals to authorize the Department of Revenue Services to verify their Title 19 status directly with the Department of Social Services, thus facilitating certain aspects of the income tax return process. It is crucial for filers to note that this form is applicable only under certain conditions: they must have been a recipient of Title 19 during the specified tax year, received Medicaid assistance for long-term care, and are unable to pay their Connecticut income tax due to a lack of funds or future income. However, it's also important to underscore that individuals who filed a joint return are not eligible to use this form due to the joint and several liabilities for tax payment shared with a spouse. This exclusion serves as a significant caveat, emphasizing the form's targeted use case. Through this form, the State of Connecticut streamlines the process for eligible individuals, ensuring that their tax obligations are assessed with due consideration of their financial assistance and care statuses.
| Question | Answer |
|---|---|
| Form Name | Form Ct 19It |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | connecticut title 19 application pdf, title 19 application form ct, title 19 application, apply for title 19 |
Department of Revenue Services
State of Connecticut
25 Sigourney St Ste 2
Hartford CT
(Rev. 12/12)
Form |
2012 |
|
|
Title 19 Status Release |
|
Place this form on top of your completed Connecticut income tax return. Complete in blue or black ink only.
Your fi rst name and middle initial |
Last name |
Social Security Number |
|
||
|
|
|
• |
• |
__ __ __ __ |
|
|
__ __ __ •• |
__ __ •• |
||
|
|
|
• |
• |
|
Mailing address (number and street), apartment number, PO box |
|
Telephone |
|
|
|
|
|
( |
) |
|
|
|
|
|
|
|
|
City, town, or post office |
State |
ZIP code |
|
|
|
|
|
|
|
|
|
Purpose |
Who May Not File Form |
Use Form
Who May File Form
If you are required to file a Connecticut income tax return, you may file Form
1.You were a Title 19 recipient during the taxable year;
2.Medicaid assisted in the payment of your
3.You do not have the funds to pay your Connecticut income tax or income available from future earnings to pay the tax.
You may not use this form if you filed a joint return with your spouse. As joint filers, you are jointly and severally liable for payment of the tax. If one spouse is on Title 19, this does not relieve the other spouse from paying the full amount of tax due.
General Information
You are required to file a Connecticut income tax return if you meet any of the following conditions:
1.You meet the gross income test (See the instructions for Form
2.You had Connecticut income taxes withheld;
3.You made estimated tax payments to Connecticut or made a payment with Form
4.You had a federal alternative minimum tax liability.
Complete Form
If the recipient has given power of attorney to another person to file Connecticut income tax returns or other Connecticut tax forms on the recipient’s behalf, attach a copy of the Power of Attorney.
Signature of recipient
Date
Signature of person with power of attorney
Date
Name of person with power of attorney (print or type)