Form Drs-Ewvr - Electronic Filing And Payment Waiver Request Form printable pdf download

Form Drs-Ewvr - Electronic Filing And Payment Waiver Request Form

Department of Revenue Services

State of Connecticut

Form DRS-EWVR

PO Box 2937

Hartford CT 06104-2937

Electronic Filing and Payment Waiver Request

General Instructions: Complete Form DRS-EWVR, Electronic Filing and Payment Waiver Request, to request a waiver of an

electronic ﬁ ling or electronic payment requirement. Mail requests to the address listed above or fax to 860-297-4761.

Only a fully completed Form DRS-EWVR will be considered for waiver by the Department of Revenue Services (DRS).

Form DRS-EWVR must be signed by the taxpayer or, in the case of corporations, estates, and trusts, the person authorized

to execute the return or pay the tax.

See Policy Statement 2011(3), Request for Waiver of Electronic Filing and Electronic Payment Requirement.

Part I

Taxpayer Information

Taxpayer’s name or business name

Social Security Number or Connecticut Tax Registration Number

Mailing address (number and street)

PO Box

Apt. no.

City

State

ZIP code

Physical address (number and street) (if different from above)

PO Box

Apt. no.

City

State

ZIP code

Daytime telephone number

For DRS use only - Case ID Number

Notice number

(

)

Part II

Electronic Filing and Payment Waiver Request

A. List the tax type(s) for which the waiver to ﬁ le or pay electronically is requested.

B. List the date you were notiﬁ ed of your obligation to ﬁ le or pay electronically.

C. State whether you currently pay any bills or meet other ﬁ nancial obligations by electronic means.

D. Describe in detail why ﬁ ling a tax return electronically or making a tax payment electronically will create an

undue hardship or; if you have been ﬁ ling returns with or making payments electronically to DRS, explain

how your circumstances have changed so that meeting such obligation would now create an undue hardship.

Include a description of any disabilities or conditions that may prevent you from meeting this obligation.

Complete Declaration section and sign on reverse.

Form Drs-Ewvr - Electronic Filing And Payment Waiver Request Form