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Department of Revenue Services

2009

Form CT-8109 (DRS)

State of Connecticut

PO Box 2931

Connecticut Withholding Tax Payment Form for Nonpayroll Amounts

Hartford, CT 06104-2931

(Rev. 12/08)

Form CT-8109 (DRS), Connecticut Withholding Tax Payment Form

If the tax liability was incurred during one quarter and paid to DRS

for Nonpayroll Amounts, is an interim coupon to be used by new

in another quarter, enter the number for the quarter in which the tax

payers or payers who have not received the 2009 Withholding

liability was incurred. For example, if the tax liability was incurred in

Remittance Coupon Book for Payers of Nonpayroll Amounts. Once

March and paid to DRS in April, enter 1 on Form CT-8109 (DRS),

the withholding book is received, use only the preprinted coupons

Line 1.

in the book.

Line 2: Weekly remitters: Enter the total amount of Connecticut

All payers of nonpayroll amounts that are subject to Connecticut

income tax withheld from nonpayroll amounts paid on the date

income tax withholding are required to withhold Connecticut income

entered above Form CT-8109 (DRS), Line 1.

tax at the time payments of nonpayroll amounts are made. Use

Monthly or Quarterly remitters: Enter the total amount of

Form CT-8109 (DRS), to make your payments to the Department

Connecticut income tax withheld from nonpayroll amounts for the

of Revenue Services (DRS). See back of return for nonpayroll

month or quarter.

amounts subject to withholding.

Pay the total amount shown on Line 2.

Each calendar year DRS classiﬁ es payers for Connecticut income

tax withholding purposes either as a weekly, monthly, or quarterly

PAYER’S RECORD OF PAYMENT

remitter. Most new payers will be classiﬁ ed as monthly remitters.

Weekly Remitters Only: Enter date nonpayroll amount was paid.

The ﬁ ling frequency is based on the payer’s reported liability

_ _ /_ _ / 2009

for the tax required to be deducted and withheld during the

look-back calendar year. The look-back calendar year for calendar

1. Enter quarter (1, 2, 3, or 4).

year 2009 is calendar year 2007. See Special Notice 2004(10),

See Instructions.

2004 Legislation Affecting Connecticut Income Tax Withholding by

Payers From Nonpayroll Amounts Paid on or After January 1, 2005,

2. Connecticut tax withheld

and the schedule on the back of this return.

See Informational Publication 2009(9), Connecticut Tax Guide

for Payers of Nonpayroll Amounts.

Make check payable to: Commissioner of Revenue Services.

Instructions

DRS may submit your check to your bank electronically. Write your

Connecticut Tax Registration Number and the calendar quarter

Complete the return in blue or black ink only.

during which the payment was made to payees on your check or

In the appropriate box, enter name, address, and identiﬁ cation

use the Taxpayer Service Center (TSC).

numbers. For weekly remitters only, enter the date the nonpayroll

amount was paid, not the due date of the coupon.

Line 1: Enter the number of the quarter during which this payment

was made to payees. Enter 1 for the 1st quarter (January 1 through

March 31); 2 for the 2nd quarter (April 1 through June 30); 3 for the

3rd quarter (July 1 through September 30); or 4 for the 4th quarter

(October 1 through December 31).

Do not ﬁ le Form CT-8109 (DRS) if no payment is due.

Separate Here and Mail Coupon to DRS. Make a Copy for Your Records.

2009

CT-8109 (DRS)

Connecticut Withholding Tax Payment Form for Nonpayroll Amounts

Connecticut Tax Registration Number

Federal Employer ID Number

Year

2009

Weekly Remitters Only: Enter date nonpayroll amount was paid.

_ _ / _ _ / 2009

Enter name and address below. Please print or type.

Name

1. Enter quarter (1, 2, 3, or 4).

See Instructions.

Address

2. Connecticut tax withheld

City

State

ZIP Code

•

Do not ﬁ le Form CT-8109 (DRS) if no payment is due.

•

Pay total amount shown on Line 2.

•

If ﬁ ling by mail, send payment to:

DRS, PO Box 2931, Hartford CT 06104-2931

•

Make check payable to:

Commissioner of Revenue Services.

•

Write your Connecticut Tax Registration Number on your check.

DO NOT FOLD OR BEND COUPON

Electronic Filing Options: Connecticut TSC ( )

Form Ct-8109 (Drs) - Connecticut Withholding Tax Payment Form For Nonpayroll Amounts

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