Form Op-210 - Room Occupancy Tax Return printable pdf download

Department of Revenue Services

For Period Ending

State of Connecticut

Form OP-210



PO Box 5031

Hartford CT 06102-5031

Connecticut Tax Registration Number

Room Occupancy Tax Return

(Rev. 03/15)



Federal Employer Identiﬁ cation Number

For periods beginning on or after January 1, 2014, Form OP-210 must be ﬁ led and paid

electronically. Do not send this paper return to DRS, unless you have been granted a waiver

by the Department of Revenue Services (DRS). See Electronic Filing Waiver, on back.

For DRS Use Only

Due date: Form OP-210 must be ﬁ led and paid on or before the twentieth day of the month

following the end of the period.

Visit to ﬁ le your

Taxpayer name

return electronically using the

This return MUST be ﬁ led electronically!

TSC or call 860-289-4829 to ﬁ le

Taxpayer

your return using Teleﬁ le.

Address

Number and street

PO box

Type

DO NOT MAIL paper return to DRS.

print.

City, town, or post ofﬁ ce

State

ZIP code



 



Check here if this is an amended return.

Complete this form in blue or black ink only.

Taxable receipts from room occupancy



Amount of tax due: Multiply Line 1 by 15% (.15).





Add Penalty

.00

and Interest

.00



Total amount due: Add Line 2 and Line 3.



Check all boxes that apply and provide the information requested:



 Permanently out of business: Enter last business date:

________

M M

D D

Y Y Y Y



 New mailing address, trade name, or physical location:

Enter new mailing address: _____________________________________________________________________

___________________________________________________________________________________________

Enter new trade name: ________________________________________________________________________

Enter new physical location: PO Box is not acceptable _______________________________________________

___________________________________________________________________________________________



 First return: Enter business start date:

________

M M

D D

Y Y Y Y



 Change in ownership: Enter date business was sold:

________

M M

D D

Y Y Y Y

New owners must obtain a new Connecticut Tax Registration Number.

Enter name of new owner: ______________________________________________________________________

Enter address of new owner: ____________________________________________________________________

___________________________________________________________________________________________

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 or document to the Department of

Revenue Services (DRS) is a ﬁ ne of not more than $5,000, imprisonment for not more than ﬁ ve 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.

Taxpayer’s Signature

Title

Date

This return MUST be ﬁ led electronically!

Taxpayer’s email address

DO NOT MAIL paper return to DRS.

Preparer’s Signature

Preparer’s Address

Date