Form Au-330 - Controlling Interest Transfer Taxes
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1
2
3Department of Revenue Services
Form AU-330
Received by DRS
State of Connecticut
PO Box 5031
Controlling Interest Transfer Taxes
Hartford CT 06102-5031
Complete this return in blue or black ink only.
(Rev. 08/10)
Check if this is an amended return.
Read instructions before completing this return.
Part I - Transferor Information
1. Name and address of transferor
2. Social Security Number or Federal Employer ID Number of transferor
3. Connecticut Tax Registration Number (if any) of transferor
SSN
FEIN
Check here if more than one transferor and attach a schedule providing the information requested above for all transferors.
Part II - Transferee Information
1. Name and address of transferee
2. Social Security Number or Federal Employer ID Number of transferee
3. Connecticut Tax Registration Number (if any) of transferee
SSN
FEIN
Check here if more than one transferee and attach a schedule providing the information requested above for all transferees.
Part III - Transfer Information
1. Name and address of entity in which controlling interest was transferred
2. Federal Employer Identifi cation Number of entity
3. Connecticut Tax Registration Number (if any) of entity
4.
The entity is a
y
Corporation
Limited Liability Compan
Trust
Partnership
Other ___________________________________
6. Date of transfer of controlling
7. Interest transferred on date
8. Was the controlling interest transfer
5. Enter name of state under whose
laws entity is organized.
interest in the entity
indicated on Line 6
made in a series of transfers? If Yes,
attach schedule describing earlier
transfers.
Yes
No
Part IV - Computation of Amount Due and Payable
00
1
Enter amount from Part V, Line 8.
1
00
2
Enter amount from Part VI, Line 8.
2
00
3
Enter amount from Part VII, Line 5.
3
00
4
Subtotal: Add Lines 1, 2, and 3.
4
00
5
Interest due, if any, on amount on Line 4
5
00
6
Penalty due, if any, on amount on Line 4
6
00
7
Total amount due: Add Lines 4, 5, and 6.
7
Declaration: 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 the Department
of Revenue Services (DRS) is a fi ne of not more than $5,000, or imprisonment for not more than fi ve 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 of principal offi cer, transferor, or authorized agent
Title
Date
Sign Here
Keep a copy
Print name of principal offi cer, transferor, or authorized agent
Telephone number
(
)
of this return
for your
Paid preparer’s signature
Date
Preparer’s SSN or PTIN
records.
Firm name and address
FEIN
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