Form Ct-990t - Unrelated Business Income Tax Return - 2004
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1
2Department of Revenue Services
Form CT-990T
2004
State of Connecticut
Connecticut Unrelated Business
(Rev. 03/05)
Income Tax Return
ENTER INCOME YEAR
BEGINNING _______________________, 2004, AND ENDING ______________________________
CT Tax Registration Number
DRS
USE ONLY
Audited By
DRS Use Only
–
– 20
F
O
Federal Employer ID Number
Init._______
CHECK AND COMPLETE ALL APPLICABLE BOXES
If the organization is annualizing its income check here
CHANGE OF:
Mailing Address
Closing Month (Attach explanation) RETURN STATUS:
Amended Return
Initial Return
Final Return
TYPE OF ORGANIZATION:
Corporation
Domestic Trust
Foreign Trust
Other (Explain) _________________________
1. Date unrelated trade or business began in Connecticut: _________________________________________
2. Nature of unrelated trade or business income activity: _______________________________________________________________________
3. CORPORATIONS ONLY: Enter state of incorporation: _________________________ Date of organization: _________________________
Date qualified in Connecticut if not incorporated in Connecticut: _______________________________________________________________
IF FINAL RETURN:
Dissolved
Withdrawn
Merged/Reorganized (Enter survivor’s CT Tax Reg. Number) ____________________________________
– ATTACH A COMPLETE COPY OF FORM 990-T INCLUDING ALL SCHEDULES AS FILED WITH THE INTERNAL REVENUE SERVICE –
COMPUTATION OF INCOME
1. Federal unrelated business taxable income (2004 federal Form 990-T, Part II, Line 34) ...............................
1
00
00
2. Federal net operating loss deduction (2004 federal Form 990-T, Part II, Line 31) .........................................
2
3. Federal deduction for Connecticut tax on unrelated business taxable income .............................................
3
00
00
4. TOTAL (Add Lines 1, 2, and 3) ...................................................................................................................
4
00
5. Refund or credit for overpayment of Connecticut tax included in federal unrelated business taxable income
5
6. Unrelated business taxable income (Subtract Line 5 from Line 4) ................................................................
6
00
COMPUTATION OF TAX
1. Unrelated business taxable income (Line 6 above) (If 100% Connecticut, enter also on Line 3.) ............
1
00
2. Apportionment fraction (Form CT-990T, Schedule A, Line 5. Carry to six places.) ...................................
2
0.
3. Connecticut unrelated business taxable income (Line 1 or Line 1 multiplied by Line 2) ...............................
3
00
00
4. Operating loss carryover (Form CT-990T, Schedule B, Line 6) .................................................................
4
5. Income subject to tax (Subtract Line 4 from Line 3) ......................................................................................
5
00
6. TAX: Multiply Line 5 by 7.5% (.075) ..............................................................................................................
6
00
COMPUTATION OF AMOUNT PAYABLE
1. Tax (From Computation of Tax, Line 6) .........................................................................................................
1
00
2. Surtax (Line 1 multiplied by 25% (.25)) ..........................................................................................................
2
00
3. Total Tax (Enter the total of Line 1 and Line 2) ..............................................................................................
3
00
4. Electronic Data Processing Equipment Property Tax Credit (Attach Form CT-1120 EDPC) ........................
4
00
5. Balance of tax payable (Subtract Line 4 from Line 3. If zero or less, enter -0-) ..........................................
5
00
Paid with application for extension (Form CT-990T EXT) ...........................................................................
6a.
6a
00
Paid with estimates (Forms CT-990T ESA, ESB, ESC, & ESD) ...................................................................
00
6b.
6b
Overpayment from prior year ........................................................................................................................
6c.
6 c
00
6. TAX PAYMENTS (Enter the total of Lines 6a, 6b, and 6c) .........................................................................
6
00
7. Balance of tax due (overpaid) (Subtract Line 6 from Line 5) ........................................................................
7
00
.00
.00
.00
8. Add Penalty
(8a) ___________ Interest
(8b) ___________ CT-1120I Interest
(8c) ___________
8
00
.00
.00
9. Amount to be credited to 2005 estimated tax
(9a) _____________ Refunded
(9b) _______________
9
00
10. Balance due with this return (Add Line 7 and Line 8) ........................................................................
10
00
Make check or money order payable to: COMMISSIONER OF REVENUE SERVICES (Attach check or money order to return with paper clip. Do not staple.)
Mail to: Department of Revenue Services, PO Box 5014, Hartford CT 06102-5014
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 to 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.
May DRS contact the preparer
Signature of Officer or Fiduciary
Date
shown below about this return?
SIGN HERE
(See instructions)
Title
Telephone Number
Keep a
(
)
Yes
No
copy
of this
Paid Preparer’s Signature
Date
Preparer’s SSN or PTIN
return for
your records.
Firm’s Name and Address
Federal Employer ID Number
Telephone Number
(
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