Form Ct-1096 Athen - Connecticut Annual Summary Andtransmittal Of Information Returns - 2016


Department of Revenue Services
Form CT-1096 ATHEN
State of Connecticut
Connecticut Annual Summary and
PO Box 5081
Hartford CT 06102-5081
Transmittal of Information Returns
(Rev. 10/16)
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
If you are required to fi le federal Form 1096, Annual Summary
amounts that include 50 through 99 cents. However, if you
and Transmittal of U.S. Information Returns, you are required
need to add two or more amounts to compute the amount
to fi le this form.
to enter on a line, include cents and round off only the total.
Do not make a payment with this return.
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 or 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 for Payments Made to Nonresident Aliens for fi ling
Enter Connecticut income tax withheld from payments made
instructions for federal Form 1042-S, Foreign Person’s U.S.
to athletes or entertainers during the 2016 calendar year.
Source Income Subject to Withholding.
This should equal the Total line on the back of this return.
For federal Form 1042-S fi lers, this is the sum of Connecticut
Special Rules for Payments Made to Nonresident
income tax withholding reported on federal Form 1042-S,
Box 17a.
If you made payments to athletes or entertainers who were
Line 2
nonresident aliens, or any other persons considered foreign
persons under the instructions for federal Form 1042-S
Enter total payments made to athletes or entertainers during
and were required to issue a federal Form 1042-S, complete
the 2016 calendar year. This should equal the sum of payments
a separate Form CT-1096 ATHEN and fi le it with a copy of
subject to Connecticut income tax withholding reported on
each federal Form 1042-S reporting Connecticut income tax
each federal Form 1099-MISC, Box 18, or each federal
Form 1042-S, Box 2, to the extent derived from services
performed in Connecticut.
Rounding Off to Whole Dollars
Line 3
You must round off cents to the nearest whole dollar on your
returns and schedules. If you do not round, the Department
Enter the number of federal Forms 1099-MISC or 1042-S
of Revenue Services (DRS) will disregard the cents.
submitted with this return.
Complete all required information on the front and back of
this return. Sign and date the return in the space provided.
Complete this return in blue or black ink only.
Separate here and mail return to DRS. Make a copy for your records.
Do not mail this form if fi ling electronically.
Department of Revenue Services
Form CT-1096 ATHEN
PO Box 5081
Connecticut Annual Summary and
Hartford CT 06102-5081
(Rev. 10/16)
Transmittal of Information Returns
1096AE 1016W 01 9999
Connecticut Tax Registration Number
Federal Employer ID Number
Due date
February 28, 2017
1. Connecticut income
tax withheld from
nonpayroll amounts
Address (number and street)
PO Box
2. Total nonpayroll amounts
reported with Form
City, town, or post offi ce
ZIP code
3. Number of 1099 or 1042-S
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 DRS is
a fi ne of not more than $5,000, or imprisonment for not more than fi ve years, or both.


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