Department of Revenue Services
Form CT-990T EXT
2014
State of Connecticut
Application for Extension of Time to File
PO Box 5014
Hartford CT 06102-5014
Unrelated Business Income Tax Return
(Rev.
12/14
)
See instructions on reverse. Complete this return in blue or black ink only.
____________________________
Enter Income Year Beginning
___________________________ , 2014, and Ending
CT Tax Registration Number
Organization name (please type or print)
Taxpayer
DRS use only
Address
Number and street
PO Box
(Please type
–
– 20
or print)
Federal Employer ID Number (FEIN)
City or town
State
ZIP code
Request for six-month extension of time to fi le Form CT-990T only
Enter above the beginning and ending dates of the organization’s income year, Connecticut Tax Registration Number, and FEIN.
Check type of organization:
Corporation
Domestic trust
Foreign trust
Other
An application for an extension to fi le Form CT-990T, with payment of tax tentatively believed to be due, must be submitted whether or not an
application for federal extension has been approved.
I request a six-month extension of time to fi le Form CT-990T, Connecticut Unrelated Business Income Tax Return, for calendar year 2014, or
until _________________________ for fi scal year ending _____________________________________ .
A federal extension will be requested on federal Form 8868, Application for Extension of Time to File an Exempt Organization Return,
for calendar year 2014, or fi scal year beginning ______________________, 2014, and ending _______________________ .
Yes
No
If No, the reason for the Connecticut extension is
_________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
Notifi cation will be sent only if extension request is denied
Tentative Return
1. Tentative amount of tax due for this income year, including surtax
00
if applicable. See instructions. ................................................................
1.
2. Reserved for future use ...........................................................................
2.
00
3. Total amount of tax due for this income year: Enter amount from Line 1.
3.
00
4a. Tax credits ................................... 4a
Computation
00
4b. Payments of estimated tax .......... 4b
00
4c. Overpayment from prior year ...... 4c
00
4. Total tax credits and payments: Add Lines 4a, 4b, and 4c. .....................
4.
00
5. Balance due with this return: Subtract Line 4 from Line 3. ..................
5.
Make check payable to Commissioner of
Mail this return to:
Visit the DRS Taxpayer
Department of Revenue Services
Revenue Services. Write the organization’s
Service Center (TSC) at
Connecticut Tax Registration Number and
State of Connecticut
to
“2014
Form CT-990T EXT” on the check
PO Box 5014
pay this return electronically.
Hartford CT 06102-5014
and attach it to the return.
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.
Name of offi cer or fi duciary (print)
Signature of offi cer or fi duciary
Date
Offi cer’s email address (print)
Title
Telephone number
(
)
Paid preparer’s signature
Date
Preparer’s SSN or PTIN
Firm’s name
FEIN
Telephone number
(
)
Firm’s address
P:\Special\AFP\PROD\FORMS\14\CT\CT-990T EXT\Form CT-990T EXT DB 20140423.indd 20140423