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STATE OF CONNECTICUT

FORM CT-1120SI

CT-1120SI

DEPARTMENT OF REVENUE SERVICES

1999

CONNECTICUT S CORPORATION

(Rev. 12/99)

INFORMATION AND COMPOSITE INCOME TAX RETURN

IMPORTANT: PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

For calendar year 1999, or other taxable year

beginning __________________ , 1999, and

ending _______________ , _______ .

Corporation Name

Federal Employer ID Number

Physical Address

Number and Street

PO Box

Date Received (FOR DEPARTMENT USE ONLY)

City or Town

State

ZIP Code

Connecticut Tax Registration Number

Check here if: Amended Return

Final Return

Total number of shareholders during the taxable year: Resident

_______ Nonresident

______

PART I

Schedule A

(See instructions)

Connecticut

Estimated

Interest

TAX

Source Income

Tax Paid,

NONRESIDENT SHAREHOLDER’S NAME

IDENTIFICATION NO.

(Form CT-2210)

(Col. B X .045)

(See Instructions)

If Any

7. Subtotal from additional schedules (if needed)

8. Total Connecticut source income (Add Lines 1 - 7, Column B)

9. Total composite return tax liability (Add Lines 1 - 7, Column C)

10. Total estimated tax paid, if any (Add Lines 1 - 7, Column D)

11. Total interest due (Add Lines 1 - 7, Column E)

PART I Schedule B

COMPUTATION OF COMPOSITE RETURN TAX DUE

1. Total Connecticut source income of nonresident individual shareholders included in composite

return (From Part 1, Schedule A, Line 8, Column B) ........................................................................

2. Tax liability: Multiply Line 1 by 4.5% (.045) ........................................................................................

3. Payments of estimated tax, if any (From Part 1, Schedule A, Line 10, Column D) ........................

4. Payment made with extension request .............................................................................................

5. Total payments (Add Line 3 and Line 4) ............................................................................................

6. If Line 5 is more than Line 2, enter amount overpaid (Subtract Line 2 from Line 5) ....................

7. Amount of Line 6 to be applied to 2000 estimated tax .....................................................................

8. Amount of Line 6 to be refunded (Subtract Line 7 from Line 6) ......................................................

9. If Line 2 is greater than Line 5, enter amount of tax owed (Subtract Line 5 from Line 2) ..............

10. If late: Enter Penalty (See instructions) ..............................................................................................

11. If late: Enter Interest (1% (.01) X number of months late, or fraction thereof X amount on Line 9) ..

12. Interest for underpayment of estimated tax (Attach Form(s) CT-2210 if applicable) .....................

13. Balance due with this return (Add Lines 9 through 12) ....................................................................

Make check or money order payable to:

COMMISSIONER OF REVENUE SERVICES

Mail to: Department of Revenue Services, PO Box 2967, Hartford CT 06104-2967 by the 15th day of the fourth month following the close of the taxable year.

DECLARATION: I declare under the penalty of false statement that I have examined this return and, to the best of my knowledge and belief, it is true,

complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.)

Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

SIGN

Signature of Officer

Title

Date

Telephone Number

HERE

(

)

Paid Preparer’s Signature

Date

Keep