Form Ct-1096 Athen - Connecticut Annual Summary And Transmittal Of Information Returns - 2014


Department of Revenue Services
Form CT-1096 ATHEN
State of Connecticut
PO Box 5081
Connecticut Annual Summary and
Hartford, CT 06102-5081
Transmittal of Information Returns
(Rev. 02/15)
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 2011(2), 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 2014 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 23.
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 2014 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.
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
2. Total nonpayroll amounts reported with
 2.
Form CT-1096 ATHEN
3. Number of 1099 or 1042-S submitted  3.
I declare under penalty of law that I have examined this return (including any
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 ____________________


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