CT-12-717A: Change of Resident Status - Special Accruals Connecticut Surety Bond Form (Revision 2017-03)
Connecticut · Connecticut DRS · Used for tax years 2024, 2025, 2026
Form CT-12-717A is a Connecticut surety bond agreement that secures future tax payments on income deferred after a change in resident status. It records the residency change, the election to defer Connecticut income tax on special accruals, the bond amount, and the obligations of
Who files this form
This bond form is for a taxpayer who changes resident status and elects under Conn. Gen. Stat. §12-717(c)(4) to defer Connecticut income tax on amounts otherwise includable on the accrual basis for the period immediately before the change.
The form states that a taxpayer must file a bond to secure future tax payments on the deferred income, calculated as if no change of residence had occurred. By making the election, the taxpayer agrees to file the required Connecticut nonresident income tax returns and include the deferred amounts.
What you'll need
Have the following information and supporting materials ready:
- Your name and Social Security number. If filing a joint return, include both names and Social Security numbers.
- The date your resident status changed, your full old and new addresses, and the applicable taxable years.
- The surety corporation’s name, state of organization, and Connecticut office address. The surety must be authorized to transact business in Connecticut.
- The bond amount and the amount by which tax would have increased without the deferral election.
- Signatures and seals of the principal and surety, with spaces provided for a spouse and the surety’s attorney-in-fact.
- Acknowledgments by both the principal and surety, and a financial statement of the surety, as noted on the form.
Keep a copy of the completed form to attach to Form CT-1040NR/PY or Form CT-1041 for the year your resident status changed.
How to file
Complete the agreement and send it by registered mail to:
Department of Revenue Services
Attention: Director, Operations Division
450 Columbus Blvd
Hartford CT 06103-1837
When filing Form CT-1040NR/PY or Form CT-1041 for the taxable year in which your resident status changed, attach a copy of this bond form to the return.
Common mistakes
- Leaving out a spouse’s information on a joint return. The form directs joint filers to include both names and Social Security numbers.
- Forgetting the return attachment. Attach a copy of this form to Form CT-1040NR/PY or Form CT-1041 for the year of the residency change.
- Omitting supporting materials. The form notes that acknowledgments by both the principal and surety and a financial statement of the surety must be added.
- Relying on an oral change or cancellation. The form states that the principal’s and surety’s obligations cannot be changed or terminated orally.
Questions people ask
What does this bond secure?
It secures future tax payments on deferred income, calculated as if no change of residence had occurred.
Who can act as the surety?
The form calls for a corporation authorized to transact business in Connecticut, with an office and usual place of business in Connecticut.
What am I agreeing to when I elect to defer the tax?
You agree to file the required Connecticut nonresident income tax returns, include the accruable amounts in computing Connecticut adjusted gross income and Connecticut source income, and consent to personal jurisdiction in Connecticut for Connecticut income tax purposes.
When does the bond obligation become void?
Under the bond’s terms, the obligation becomes void if you pay the full deferred tax and any penalties and interest, or report all the specified accruable items of income, gain, loss, or deduction for the applicable taxable years. Otherwise, it remains irrevocable and in full force and effect.
Do I attach this form to my tax return?
Yes. Attach a copy when filing Form CT-1040NR/PY or Form CT-1041 for the taxable year in which your resident status changed.