CT-12-717B: Change of Resident Status - Special Accruals Other Acceptable Security Form (Revision 2017-03)
Connecticut · Connecticut DRS · Used for tax years 2024, 2025, 2026
Form CT-12-717B is an agreement for taxpayers changing from Connecticut resident to nonresident status who elect to report the period before the change on a cash receipts basis. It records the tax increase that would apply without the election, the security provided for the defer
Who files this form
Form CT-12-717B is for individuals who change their Connecticut income tax residency from resident to nonresident and elect under Conn. Gen. Stat. §12-717(c)(4) to report the period before the change on the cash receipts basis.
The form documents that election and the security provided to the Department of Revenue Services (DRS) for the deferred tax. If filing a joint return, include both names.
What you'll need
Have your name, Social Security number, address as shown on your return, date of residency change, and the amount by which your tax would have increased without the election. For a joint return, include your spouse’s name and Social Security number.
Provide the documents for the security you are using:
- Bank passbooks or certificates of deposit: A letter on the bank or financial institution’s letterhead, signed by an officer. It must identify the accounts, confirm that principal cannot be withdrawn without DRS’s written consent, and state that the institution’s right of setoff for a defaulted obligation is subordinate to DRS’s interest. Enter the institution, amount, and certificate of deposit maturity date, if applicable.
- Standby letter of credit: Attach an irrevocable standby letter of credit payable to DRS. Enter the issuer or confirming bank, expiration date, and amount.
- Gambling winnings: Attach a completed federal Form W-2G showing Connecticut income tax withheld from your Connecticut lottery payments.
How to file
Complete, sign, and date the agreement. Your spouse must also sign if you are filing a joint return.
Send the agreement with the security by registered mail to:
Department of Revenue Services
Attention: Director, Operations Division
450 Columbus Blvd Ste 1
Hartford CT 06103-1837
Attach a copy of this form to Form CT-1040NR/PY or Form CT-1041 when filing for the taxable year in which your residency changed.
Common mistakes
- Leaving out one spouse’s name on a joint return. The form says to include both names.
- Omitting Social Security numbers. Enter the applicable numbers in the spaces provided.
- Forgetting to attach a copy to Form CT-1040NR/PY or Form CT-1041 for the year of the residency change.
- Sending the agreement without the security or without using registered mail.
Questions people ask
What income must I report in later years under this agreement?
You agree to include all income and gain accrued before your residency change in subsequent Connecticut returns as if your residency had not changed, and to pay the tax when due.
When will DRS return my security?
If DRS has not disposed of it under the agreement, the security will be returned when DRS determines it is no longer needed because of full or partial payment of the deferred tax.
Who receives interest earned on the security?
Any interest accruing on the security belongs to you.
What happens if I do not report the required income, pay the tax, or maintain adequate security?
If DRS makes one of these determinations, the full accruable income is assigned to the period before your residency change, and the recomputed additional tax becomes due immediately. DRS may dispose of the security if you do not pay the tax or replace inadequate security within the applicable 30-day period after notice is mailed. Proceeds may cover the deferred tax, interest, and penalties; any balance is paid to you.