PART II . – WHERE FORM CT-590 MUST BE SUBMITTED TO DRS
DECLARATION BY NONRESIDENT PERFORMER WITH ANNUAL CONNECTICUT SOURCE INCOME OF $3,000 OR LESS
I am not a resident of Connecticut and reside at the address shown above. I expect to be paid $3,000 or less, in the aggregate, during the
calendar year for services performed in Connecticut. If I am paid more than $3,000, in the aggregate, for services performed in Connecticut
during the calendar year, I will promptly inform you. I understand that, even if Connecticut income tax is not withheld from the payment made
to me for my performance in Connecticut at the above-named venue on the above-specified date(s) of performance, the payment remains
subject to Connecticut income tax. I declare under penalty of law that the information contained on this form is, to the best of my knowledge
and belief, true, complete, and correct. I understand that the penalty for willfully delivering a false statement to DRS is a fine of not more than
$5,000, or imprisonment for not more than five years, or both.
Signature
Date
DECLARATION BY PERFORMING ENTITY REGISTERED AS EMPLOYER WITH DRS
The performing entity named above is registered with DRS to withhold Connecticut income tax as an employer and will withhold and pay
over Connecticut income tax on behalf of members or participants in the performing entity for services performed at the above-named
venue on the above-specified date(s) of performance. The performing entity has filed all required Connecticut tax returns, past and
present, and has paid all required Connecticut taxes. Should the performing entity cease to be registered with DRS to withhold Connecticut
income tax as an employer, I will promptly inform you. I declare under penalty of law that the information contained on this form is, to the
best of my knowledge and belief, true, complete, and correct. I understand that the penalty for willfully delivering a false statement to DRS
is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Name and Title (type or print)
Signature
Date
Form CT-590 Back (Rev. 01/2002)
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