Form Ct-941x - Amended Connecticut Reconciliation Of Withholding

Department of Revenue Services

Form CT-941X

PO Box 2931

Hartford, CT 06104-2931

Amended Connecticut Reconciliation of Withholding

Complete this return in blue or black ink only. See instructions on back before completing.

(Rev. 12/12)

Name of employer

Connecticut Tax Registration Number



Address (number and street)

Federal Employer ID Number (FEIN)

City, town, or post ofﬁ ce

State

ZIP code





Name of form being amended (check one):

Form CT-941

Form CT-945

Form CT-941 HHE Household employer

Quarter being amended (Form CT-941 ﬁ lers only, check one) and enter calendar year (all ﬁ lers):

Calendar

year



1st Quarter

2nd Quarter

3rd Quarter

4th Quarter





 

 _________________

January - March



A pril - June



July - September

October - December

Column A

Column B

Column C

Amount as Originally

Net Change

Corrected

Reported on

Amount

(Increase or Decrease)

CT-941 or CT-945

1. Enter gross wages from Form CT-941, Line 1, or





gross nonpayroll amounts from Form CT-945, Line 1. ..........1.

2. Enter gross CT wages from Form CT-941, Line 2, or gross





CT nonpayroll amounts from Form CT-945, Line 2. ...............2.

3. Enter CT tax withheld from Form CT-941 or





Form CT-945, Line 3. .............................................................3.

4. Enter credit from prior quarter, if any, of the same





calendar year (Form CT-941 ﬁ lers only). .............................4.

5. Deposits made with Form CT-WH (Form CT-941) or





Form CT-8109 (Form CT-945) ................................................5.

6. Amount paid with Form CT-941, Form CT-945,





or Form CT-941 HHE .............................................................6.





7. Total payments: Add Lines 4, 5, and 6. ..................................7.

8. Overpayment, if any, as shown on original return (or as previously adjusted) .......................................... 8.



9. Subtract Line 8 from Line 7. ...................................................................................................................... 9.



10. Net tax due or (credit): Subtract Line 9 from Line 3. ............................................................................... 10.



11. Interest on net tax due ............................................................................................................................. 11.



12. Total amount due or (credit): Add Line 10 and Line 11. Credits cannot be transferred to

another account. ................................................................................................................................... 12.



Overpayment: If amount on Line 12 is a credit, enter the overpayment

Use the Taxpayer Service Center (TSC) to electronically

amount here



$ ________________

and check if:

ﬁ le this return. See TSC on back.





Applied to next return or

Refunded

If ﬁ ling by mail, make check payable to Commissioner of Revenue

Services. Write your CT Tax Registration Number on your check. Do

Declaration: I declare that (check the appropriate box)

not send cash. The Department of Revenue Services (DRS) may submit





All overwithheld Connecticut income taxes for the current calendar

your check to your bank electronically.

year were repaid to employees prior to the end of the current calendar

Attach a copy of all applicable schedules and forms.

year. (You must keep in your records each employee’s written receipt

Mail to:

Department of Revenue Services

showing the date and amount of repayment.)

PO Box 2931



None of this refund or credit was withheld from employees.

Hartford CT 06104-2931

I further 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 DRS is a ﬁ ne of not

more than $5,000, imprisonment for not more than ﬁ ve years, or both.

Signature of employer

Date

Sign Here

Keep a copy

Paid preparer’s signature

Date

FEIN

of this return



for your

Firm name and address