Form Ct-8809 Request For Extension Of Time To File Informational Returns - Connecticut
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1Department of Revenue Services
State of Connecticut
Form CT-8809
PO Box 2930
Hartford CT 06104-2930
Request for Extension of Time to
(Rev. 12/07)
File Informational Returns
(For Forms W-2, W-2G, 1098, 1099-R, and 1099-MISC)
Complete this form in blue or black ink only.
1. Filer or transmitter name and mailing address (number and street including room
2. Connecticut Tax Registration Number
or suite number, or PO box, city, state, and ZIP code)
Extension
Request for
3. Federal Employer Identification Number (FEIN)
Calendar
Year
4. Person to be contacted about this request
5. Telephone number
200__
(
)
6. Check the boxes that apply. You need not enter the number of returns.
Paper
Paper
Paper
Combined
Type of
Type of
Type of
Electronic
Electronic
Electronic
CD
Returns
Returns
CD
Returns
CD
Filer
Return
Return
Return
( )
( )
( )
( )
( )
( )
( )
( )
( )
( )
W-2
1098
1099-R
1099-MISC
W-2G
7. Has an extension of time to file federal informational returns been requested from the Internal Revenue Service?
No
Yes
Pending
(If Yes, attach a copy of federal Form 8809, Application for Extension of Time to
File Informational Returns.)
If Yes, was the request for extension approved?
( If Yes, attach a copy of the extension request approval .)
No
Yes
8. State in detail why you need an extension. If you need more space, attach additional page(s).
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
9. Will you provide, or have you provided, a copy of the informational return or the required statement to the recipient on time?
See instructions.
No
Yes
Declaration:
I declare under the 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 the Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment for not more than five years, or
both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature
Title
Date
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