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Department of Revenue Services

2015

Form CT-1096 ATHEN

State of Connecticut

PO Box 5081

Connecticut Annual Summary and

Hartford, CT 06102-5081

Transmittal of Information Returns

(Rev. 10/15)

General Instructions

Round down to the next lowest dollar all amounts that include

1 through 49 cents. Round up to the next highest dollar all

Complete this return in blue or black ink only.

amounts that include 50 through 99 cents. However, if you need

If you are required to ﬁ le federal Form 1096, Annual Summary

to add two or more amounts to compute the amount to enter on

and Transmittal of U.S. Information Returns, you are required

a line, include cents and round off only the total.

to ﬁ le this form.

Example: Add two amounts ($1.29 + $3.21) to compute the

See Policy Statement 2015(5), Income Tax Withholding for

total ($4.50) to enter on a line. $4.50 is rounded to $5.00 and

Athletes and Entertainers.

entered on the line.

Submit Form CT-1096 ATHEN with federal Forms 1099-MISC,

Line Instructions

Miscellaneous Income, reporting Connecticut income tax

Line 1

withholding information in Boxes 16 and 18. See Special Rules

Enter Connecticut income tax withheld from payments made

for Payments Made to Nonresident Aliens for ﬁ ling instructions

to athletes or entertainers during the

2015

calendar year. This

for federal Form 1042-S, Foreign Person’s U.S. Source Income

should equal the Total line on the back of this return. For federal

Subject to Withholding.

Form 1042-S ﬁ lers, this is the sum of Connecticut income tax

Special Rules for Payments Made to Nonresident

withholding reported on federal Form 1042-S, Box 21.

Aliens

Line 2

If you made payments to athletes or entertainers who were

Enter total payments made to athletes or entertainers during

nonresident aliens, or any other persons considered foreign

the

2015

calendar year. This should equal the sum of payments

persons under the instructions for federal Form 1042-S

subject to Connecticut income tax withholding reported on

and were required to issue a federal Form 1042-S, complete a

each federal Form 1099-MISC, Box 18, or each federal

separate Form CT-1096 ATHEN and ﬁ le it with a copy of each

Form 1042-S, Box 2, to the extent derived from services

federal Form 1042-S reporting Connecticut income tax withheld.

performed in Connecticut.

Rounding Off to Whole Dollars

Line 3

You must round off cents to the nearest whole dollar on your

Enter the number of federal Forms 1099-MISC or 1042-S

returns and schedules. If you do not round, the Department of

submitted with this return.

Revenue Services (DRS) will disregard the cents.

Complete all required information on the front and back of this

return. Sign and date the return in the space provided.

Do not make a payment with this return.



Separate here and mail return to DRS. Make a copy for your records.

2015

CT-1096 ATHEN

Connecticut Annual Summary and Transmittal of Information Return



Connecticut Tax Registration Number

Federal Employer ID Number

Due date



1. Connecticut income tax withheld from

Enter name and address below. Please print or type.

 1.

Connecticut nonpayroll amounts

Name

2. Total nonpayroll amounts reported with

 2.

Form CT-1096 ATHEN

Address

3. Number of 1099 or 1042-S submitted  3.

I declare under penalty of law that I have examined this return (including any

City

State

ZIP code

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.

Do not send a payment with this return.

Mail to:

Department of Revenue Services

Signature _____________________________________________________________

State of Connecticut

PO Box 5081

Hartford CT 06102-5081

Title _____________________________________ Date ____________________

P:\Special\AFP\PROD\FORMS\15\CT\CT-1096 ATHEN\CT-1096 ATHEN 20151013.indd

20151013 3:55 PM

Form Ct-1096 Athen Draft - Connecticut Annual Summary And Transmittal Of Information Returns - 2015

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