Cert-103 - Residential Condominium Association Page 2
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2Name of Residential Condominium Assn. Address
CT Tax Registration Number
Federal Employer ID #
(If none, explain)
Name of Service Provider
Address
CT Tax Registration Number
Federal Employer ID #
(If none, explain)
General Description of services being rendered to residential condominium association by service provider
Period covered by this certificate:
(Calendar Year
)
Declaration by Condominium Association
As of the first day of the calendar year covered by this certificate, there were
units in this residential condominium
association of which
units were not occupied by their owners as dwellings. This information concerning occupancy
was obtained from unit owners.
In accordance with Conn. Agencies Regs. §12-407(2)(i)(I)-1(f)(4), because
% of the units were not owner-occupied,
the same percentage of any charges made to this condominium association by any service provider rendering services to
industrial, commercial, or income-producing real property, as defined in Conn. Agencies Regs. §12-407(2)(i)(I)-1(g), is subject
to sales and use taxes at the rate of 6% during the calendar year covered by this certificate.
Declaration: I declare under penalty of law that I have examined this return or document (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 fine of not more than $5,000, or imprisonment for not more
than five years, or both.
Name of Condominium Association
By:
Signature of Principal Officer
Title
Date
CERT-103 (Back)
(Rev. 01/05)
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