Form CT-1096 2013 Connecticut Annual Summary and Transmittal of Information Returns

Distributions from pensions annuities retirement or pro t sharing plans as reported on federal Form 1099 R but only if Connecticut income tax was withheld Federal Form 1099 MISC for payments made to resident individuals or to nonresident individuals if the payments relate to services performed wholly or partly in Connecticut even if no Connecticut income tax was withheld; and Federal Form 1099 R reporting distributions from pensions annuities retirement or pro t sharing plans but only if Connecticut income tax was withheld PO Box 5081 Hartford CT 06102 5081 (Rev 12/12) 1 Connecticut income tax withheld fromName Connecticut nonpayroll amounts 1 2 Total nonpayroll amounts reported with Form CT 1096 2 3 Number of 1099 MISC 1099 R or W 2Gs submitted 3 Address All payments must be made using Form CT 8109 (DRS) Connecticut Withholding Tax Payment Form for Nonpayroll Amounts Form CT 945 Connecticut Annual Reconciliation of Withholding for Nonpayroll Amounts or Form CT 941X Amended Connecticut Reconciliation of Withholding Amending Form CT 1096 Amounts April 1 2nd Attach Form CT 1096 (DRS) and every Copy 1 of the following: Calendar year ending City State ZIP code Complete all required information on the front and back of this return Sign and date the return in the space provided Complete for Each Period Complete this return in blue or black ink only Connecticut Annual Summary and Transmittal of Information Returns Connecticut Income Tax Connecticut Lottery winnings paid to resident and nonresident individuals as reported on federal Form W 2G whether or not Connecticut income tax was withheld; Connecticut Tax Registration Number CT 1096 (DRS) Back (Rev 12/12) CT 1096 (DRS) Connecticut Annual Summary and Transmittal of Information Returns 2013 December 31 Quarter Department of Revenue Services PO Box 5081 Do not make a payment with this return Do not send payment with this return Due date Electronic Filing Requirements Read instructions on back before completing this form Electronic Filing Requirements Taxpayers who le 25 or more Forms 1099 MISC 1099 R or W 2G are required to le Form CT 1096 and Forms 1099 MISC 1099 R or W 2G electronically You may request a waiver of the electronic ling requirements by completing Form CT 8508 Request for Waiver From Filing Informational Returns Electronically on or before January 15 2014 Electronic reporting requirements are available on the DRS website at www ct gov/DRS/ew2 or by calling DRS at 1 800 382 9463 (Connecticut calls outside the Greater Hartford calling area only) or 860 297 5962 (from anywhere) TTY TDD and Text Telephone users only may transmit inquiries anytime by calling 860 297 4911 Electronic reporting requirements are available on the DRS website at www ct gov/DRS/ew2 or by calling DRS at 800 382 9463 (Connecticut calls outside the Greater Hartford calling area only) or 860 297 5962 (from anywhere) TTY TDD and Text Telephone users only may transmit inquiries anytime by calling 860 297 4911 Enter name and address below Please print or type equal Line 1 on the 00 Example: Add two amounts ($1 29 + $3 21) to compute the total ($4 50) to enter on a line $4 50 is rounded to $5 00 and entered on the line February 28 2014 Federal Employer ID Number federal Form 1099 MISC 1099 R or W 2G to the address on the Federal Form 1099 MISC for payments made to resident individuals or to nonresident individuals if the payments relate to services performed wholly or partly in Connecticut even if Connecticut income tax was not withheld; and Federal Form 1099 R reporting distributions from pensions annuities retirement or pro t sharing plans but only if Connecticut income tax was withheld Federal Form W 2G for (1) Connecticut Lottery winnings paid to resident and nonresident individuals even if no Connecticut income tax was withheld; and (2) other gambling winnings paid to resident individuals even if no Connecticut income tax was withheld; Federal Form W 2G for (1) Connecticut Lottery winnings paid to resident or nonresident individuals even if Connecticut income tax was not withheld; and (2) other gambling winnings paid to resident individuals even if Connecticut income tax was not withheld; Federal Forms 1099 MISC 1099 R and W 2G must be filed with DRS even if you are not required to be registered with DRS Unregistered lers should write Information Only in the space reserved for the Connecticut Tax Registration Number on this return Form CT 1096 (DRS) Form CT 1096 (DRS) may be used by new payers or payers who have not received their 2013 Connecticut Payer of Nonpayroll Amounts Withholding Returns and Instructions Forms and Publications Visit the DRS website at www ct gov/DRS to download and print Connecticut tax forms and publications front of this return General Instructions Group the forms by form number and send each group with a Hartford CT 06102 5081 I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and to the best of my knowledge and belief it is true complete and correct I understand the penalty for willfully delivering a false return or document to DRS is a ne of not more than $5 000 imprisonment for not more than ve years or both If filing electronically Form CT 1096 is due the last day of March 2014 Do not mail Form CT 1096 (DRS) if you are ling electronically If ling by paper Form CT 1096 (DRS) is due the last day of February 2014 If the due date falls on a Saturday Sunday or legal holiday the next business day is the due date See Who Must File Form CT 1096 (DRS) on back page If you are not required to le federal Form 1096 you are not required to le Form CT 1096 (DRS) Special rules apply to designated withholding agents See Policy Statement 2011(2) Income Tax Withholding for Athletes or Entertainers If you are required to file federal Form 1096 you must file Form CT 1096 (DRS) with the Department of Revenue Services (DRS) and attach every state copy of: If you file 25 or more Forms 1099 MISC 1099 R or W 2G you are required to file Form CT 1096 (DRS) and Forms 1099 MISC 1099 R or W 2G electronically You may request a waiver of the electronic filing requirements by completing Form CT 8508 Request for Waiver From Filing Informational Returns Electronically on or before January 15 2014 If you le 24 or fewer Forms 1099 MISC 1099 R or W 2G you may le using paper forms without requesting a waiver January 1 1st July 1 3rd June 30 Quarter Line 1: Enter Connecticut income tax withheld from Connecticut Line 2: Enter total: Line 3: Enter the number of 1099 MISC 1099 R or W 2G forms submitted with this return Line Instructions Mail to: Department of Revenue Services March 31 Quarter Miscellaneous payments reported on federal Form 1099 MISC to resident individuals or to nonresident individuals if the payments relate to services performed wholly or partly in Connecticut even if no Connecticut income tax was withheld; and nonpayroll amounts during the calendar year This should equal the October 1 4th Other gambling winnings paid to resident individuals as reported on federal Form W 2G whether or not Connecticut income tax was withheld; Period Withheld From Nonpayroll return below Round down to the next lowest dollar all amounts that include 1 through 49 cents Round up to the next highest dollar all amounts that include 50 through 99 cents However if you need to add two or more amounts to compute the amount to enter on a line include cents and round off only the total Rounding Off to Whole Dollars See Informational Publication 2013(8) Connecticut Tax Guide for Payers of Nonpayroll Amounts separate Form CT 1096 Separate here and mail return to DRS Make a copy for your records September 30 Quarter Signature State of Connecticut Taxpayer Service Center (TSC) The TSC allows taxpayers to electronically file pay and manage state tax responsibilities To make electronic transactions or administer your tax account online visit www ct gov/TSC and select Business Taxpayers who le 24 or fewer Forms 1099 MISC 1099 R or W 2G are encouraged to le electronically but may use paper forms without requesting a waiver If you le 24 or fewer Forms 1099 MISC 1099 R or W 2G and choose to le using paper forms mail your completed return to the address on the coupon The gross Connecticut nonpayroll amounts reported on Form CT 945 or Form CT 941X Line 2 must agree with total nonpayroll amounts reported on Form CT 1096 Line 2 Title Date To amend Form CT 1096 submit a revised Form CT 1096 clearly labeled AMENDED The total Connecticut tax withheld on Form CT 945 or Form CT 941X Line 3 must agree with the total reported on Form CT 1096 Line 1 Total Line on the back of this return Total: This should Use the Taxpayer Service Center (TSC) to electronically le this return See TSC on back If ling by paper mail your completed return and every copy 1 of When to File Where to File Who Must File Form CT 1096 (DRS) You must round off cents to the nearest whole dollar on your returns and schedules If you do not round the Department of Revenue Services (DRS) will disregard the cents