Form Reg-14 - Application For Commercial Fisherman Tax Exemption Permit - Connecticut Department Of Revenue Services

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Department of Revenue Services
Form REG-14
State of Connecticut
25 Sigourney Street
Application for
For Department Use Only
Hartford CT 06106
Commercial Fisherman Tax Exemption Permit
Connecticut Tax Registration Number
Rev. 05/05
Conn. Gen. Stat. §12-412 (40)
Taxpayer Services Number
Commercial Fisherman Tax Exemption Permit valid
from
until
Social Security Number (Individual)
Please correct
name and
— — — — — — — —
address
Federal Employer ID Number (Other)
if shown
incorrectly
at right
Check One:
Check One:
Individual
New
Partnership
Renewal
Name of Vessel
Telephone Number
Corporation
Business
LLC
Structure
Home Port
LLP
Changed
Fiduciary
Start-up
DMV Vessel Registration
U.S. Coast Guard Documentation Number
DEP License Number
This certifies that at least 50% of last year’s gross income was derived from commercial fishing.
Applicant’s Signature
Title
Date
Please complete this application and return to:
Department of Revenue Services
State of Connecticut
Taxpayer Services Division
25 Sigourney Street
Hartford CT 06106-5032
Enclose a copy of the applicant’s prior year Federal Income Tax Return and all accompanying schedules.
Form REG-14 should be completed and filed with the Department of Revenue Services (DRS) by June 1st so that DRS can make
a determination and issue a permit by the effective date. Your 2005 Fisherman Tax Exemption Permit is valid from July 1, 2005,
until June 30, 2007. If this application is submitted after June 1st, the permit is valid on the date indicated on the permit.
Start-up fisherman: The expiration date is 24 months from the date the permit is issued.
If you operate more than one vessel, attach a separate sheet listing the name, home port, Department of Motor Vehicles (DMV)
vessel registration, and Department of Environmental Protection (DEP) license number for each vessel. If you are not a
Connecticut resident and are not required to have a DMV vessel registration or a DEP license number, leave these lines blank
and enter your U.S. Coast Guard documentation number.
For Further Information: Call Taxpayer Services at 1-800-382-9463 (in-state) or 860-297-5962 (from anywhere). TTY, TDD, and Text
Telephone users only may transmit inquiries 24 hours a day by calling 860-297-4911. See Informational Publication
2005(8), Fisherman’s Guide to Sales and Use Taxes and Estimated Income Tax, for more information.
For Department Use Only
Approved
Disapproved
Commissioner’s
Authorized Agent _________________________________________________________
Title _________________________________________________________
Date _________________________________________________________

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