Form Ct- 6559a - Submitter Report For Form W-2 Compact Disc (Cd) Filing Continuation Sheet
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1Department of Revenue Services
Form CT- 6559A
State of Connecticut
Submitter Report for Form W-2 Compact Disc (CD) Filing
PO Box 2930
Continuation Sheet
Hartford CT 06104-2930
Page ____ of ____
(Rev. 10/09)
Complete this form in blue or black ink only. See Form CT-6559 for instructions on how to complete this form.
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)
10. Employer summary of W-2 forms reported on CD. Complete for each employer submitted.
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
Total Connecticut wages reported
$
Total Connecticut wages reported
$
$
Connecticut tax withheld from wages
Connecticut tax withheld from wages
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
Total Connecticut wages reported
$
Total Connecticut wages reported
$
Connecticut tax withheld from wages
$
Connecticut tax withheld from wages
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
Total Connecticut wages reported
$
Total Connecticut wages reported
$
Connecticut tax withheld from wages
$
Connecticut tax withheld from wages
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
$
Total Connecticut wages reported
Total Connecticut wages reported
$
$
Connecticut tax withheld from wages
Connecticut tax withheld from wages
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