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Department of Revenue Services State of Connecticut (Rev. 12/16) 1040 1216W 01 9999Form CT1040 For DRS Use OnlyTaxpayers must sign declaration on reverse side. Print your SSN, name, mailing address,
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m m - d stands for miscellaneous income, often used to report income that doesn't fit into other categories on tax forms.
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You must report the recipient's name, address, and taxpayer identification number, as well as the amount of miscellaneous income received.
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