Form Ct-W4t-2011 - Wihholding Certificate
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1Department of Revenue Services
2011
State of Connecticut
Form CT-W4T
(New 10/11)
CT-W4T
2011 Withholding Certifi cate
Complete this certifi cate in blue or black ink only.
Purpose
Where to File
Form CT-W4T allows Connecticut taxpayers to instruct
Send this certificate to your employer’s payroll
their employer to withhold Connecticut income tax at a
department. Keep a copy for your records. Do not send
fl at dollar amount.
this certifi cate to the Department of Revenue Services
(DRS).
Form CT-W4T may be used by Connecticut taxpayers
who receive supplemental compensation or are
For More Information
otherwise impacted by the catch-up withholding
Call DRS during business hours, Monday through
calculation rules to adjust their Connecticut income tax
Friday:
withholding to a fl at dollar amount.
• 1-800-382-9463 (Connecticut calls outside the
Reminder for Taxable Year 2012: If you adjust your
Greater Hartford calling area only); or
withholding using Form CT-W4T, your employer will
continue to withhold the amount of Connecticut income
• 860-297-5962 (from anywhere).
tax that you request until you provide your employer
TTY, TDD, and Text Telephone users only may
with a new Form CT-W4, Employee’s Withholding
transmit inquiries anytime by calling 860-297-4911.
Certifi cate. Therefore, as the “catch-up” withholding
requirements for 2011 do not apply in 2012, employees
Forms and Publications
who complete a Form CT-W4T should check with their
Visit the DRS website at to download
payroll offi ces or departments to determine the date
and print Connecticut tax forms and publications.
they must submit a new Form CT-W4 in order for it to
be effective by January 1, 2012.
General Instructions
If you wish to have Connecticut income tax withheld at
a fl at dollar amount, complete the projected withholding
worksheet to calculate the amount to withhold and enter
the amount on Form CT-W4T, Line 1.
2011 Form CT-W4T
Department of Revenue Services
2011 Withholding Certifi cate
State of Connecticut
First name
Middle initial
Last name
Social Security Number
•
•
___ ___ ___ ___ ___ ___ ___ ___ ___
•
•
•
•
Home address
PO Box
City or town
State
ZIP code
1. Connecticut income tax to be withheld each pay period: Enter amount from
00
Projected Withholding Worksheet, Line 10. ....................................................1.
Employee’s signature
Date
Sign
Here
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