Form Ct- 6559a - Continuation Sheet For Form Ct-6559 Submitter Report For Form W-2 Compact Disc (Cd) Filing
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1Department of Revenue Services
Form CT- 6559A
State of Connecticut
Continuation Sheet for Form CT-6559
PO Box 2930
Submitter Report for Form W-2 Compact Disc (CD) Filing
Hartford CT 06104-2930
Page ____ of ____
(Rev. 09/08)
See Form CT-6559 for instructions on how to complete this continuation sheet.
Year for which CDs are submitted
Submitter’s Connecticut Tax Registration Number
Submitter’s Federal Employer Identifi cation Number (FEIN)
Name and address of submitter (include street, PO Box, city, state, and ZIP Code)
12. Employer Summary of Form W-2 CD Wage Information
12. Employer Summary of Form W-2 CD Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
FEIN
Number of W-2s submitted
Number of W-2s submitted
Form W-2 - Connecticut Summary
Form W-2 - Connecticut Summary
Total Connecticut wages reported
Total Connecticut wages reported
Connecticut tax withheld from wages
Connecticut tax withheld from wages
12. Employer Summary of Form W-2 CD Wage Information
12. Employer Summary of Form W-2 CD Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
FEIN
Number of W-2s submitted
Number of W-2s submitted
Form W-2 - Connecticut Summary
Form W-2 - Connecticut Summary
Total Connecticut wages reported
Total Connecticut wages reported
Connecticut tax withheld from wages
Connecticut tax withheld from wages
12. Employer Summary of Form W-2 CD Wage Information
12. Employer Summary of Form W-2 CD Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
FEIN
Number of W-2s submitted
Number of W-2s submitted
Form W-2 - Connecticut Summary
Form W-2 - Connecticut Summary
Total Connecticut wages reported
Total Connecticut wages reported
Connecticut tax withheld from wages
Connecticut tax withheld from wages
12. Employer Summary of Form W-2 CD Wage Information
12. Employer Summary of Form W-2 CD Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
FEIN
Number of W-2s submitted
Number of W-2s submitted
Form W-2 - Connecticut Summary
Form W-2 - Connecticut Summary
Total Connecticut wages reported
Total Connecticut wages reported
Connecticut tax withheld from wages
Connecticut tax withheld from wages
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