Form Ct-941 - Connecticut Quarterly Reconciliation Of Withholding - 2001

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2001
FORM CT-941 (DRS)
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
(Rev. 12/00)
Purpose: The attached Quarterly Reconciliation of Withholding
Seasonal filers must obtain permission from DRS to file for only
coupon may be used by new employers who have not received the
the quarters in which they are active. Annual filers who withhold
Employer’s Withholding Remittance Coupon Book for 2001.
Connecticut income tax from nonpayroll amounts only must obtain
permission from DRS to file only for the fourth quarter. Household
All employers registered for Connecticut income tax withholding
employers who voluntarily register with DRS may request annual
are required to file Form CT-941, Connecticut Quarterly
filing. See Informational Publication 2000 (11), Connecticut Circular
Reconciliation of Withholding . You must file a quarterly reconciliation
CT - Employer’s Tax Guide, for detailed information on how to obtain
as long as you have an active withholding account with the
permission to become a seasonal or annual filer.
Department of Revenue Services (DRS), even if no tax is due, or if
no tax was required to be withheld for that quarter. In general, Form
Be sure to complete all requested information on the back of this
CT-941 must be filed even if you are not required to file federal
return. See instructions on back. Sign and date the return in the
Form 941 (for example: household employers, agricultural
space provided. If payment is due, remit payment with this return.
employers, payers of nonpayroll amounts, and intermittent filers).
Make your check payable to: COMMISSIONER OF REVENUE
Due dates: First Quarter, April 30, 2001; Second Quarter,
SERVICES. Write your Connecticut Tax Registration Number, and
July 31, 2001; Third Quarter, October 31, 2001; Fourth Quarter,
the calendar quarter to which the payment applies, on your check.
January 31, 2002. An employer who made full and timely payments of
Mail your completed return and payment (if applicable) to: Department
all income tax withholding for the quarter, may file the return by the 10th
of Revenue Services, PO Box 2931, Hartford CT 06104-2931.
day of the second calendar month following the end of the quarter. If
To amend Form CT-941, use Form CT-941X, Amended
you are a household employer and permitted by DRS to file one return
Connecticut Quarterly Reconciliation of Withholding. Forms
annually, the due date of Form CT-941 is April 15, 2002.
and publications may be obtained by visiting the DRS Web
If the due date falls on a Saturday, Sunday or legal holiday, the next
site at or by calling the DRS Forms Unit
business day is the due date.
at 860-297-4753 (from anywhere).
<
CT-941 (DRS)
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
2001
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
ENTER REPORTING QUARTER (1, 2, 3 OR 4)
DUE DATE
<
<
READ INSTRUCTIONS BEFORE COMPLETING
<
1. GROSS WAGES AND NONPAYROLL AMOUNTS
1
ENTER NAME AND ADDRESS BELOW. PLEASE PRINT OR TYPE.
<
2. GROSS CT WAGES AND NONPAYROLL AMOUNTS
2
<
3. CONNECTICUT TAX WITHHELD
3
<
4. CREDIT FROM PRIOR PERIOD
4
<
TAXPAYER’S COPY
5. PAYMENTS MADE FOR THIS QUARTER
5
<
6. TOTAL DEPOSITS (Add Line 4 and Line 5)
6
<
7. NET TAX DUE (OR CREDIT) (Line 3 minus Line 6)
7
<
<
8a. PENALTY:
+ 8b. INTEREST:
= 8
H
<
Check if you are a household employer.
9. AMOUNT APPLIED TO NEXT QUARTER
9
<
H
Check if you no longer have employees in Connecticut
10. AMOUNT TO BE REFUNDED
10
<
and enter date of last payroll: _____________________ .
11. TOTAL AMOUNT DUE (Add Line 7 and Line 8)
11
I declare under the penalty of false statement that I have examined this return and, to the best of my knowledge and belief, it is true, complete, and correct. (The penalty for false statement
is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.)
Signature ________________________________________________________
Title ____________________________________________ Date ___________
SEPARATE HERE AND MAIL COUPON TO DEPARTMENT OF REVENUE SERVICES. KEEP THE TOP PORTION FOR YOUR RECORDS.
<
CT-941 (DRS)
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
2001
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
ENTER REPORTING QUARTER (1, 2, 3 OR 4)
DUE DATE
<
<
READ INSTRUCTIONS BEFORE COMPLETING
<
1. GROSS WAGES AND NONPAYROLL AMOUNTS
1
ENTER NAME AND ADDRESS BELOW. PLEASE PRINT OR TYPE.
<
2. GROSS CT WAGES AND NONPAYROLL AMOUNTS
2
<
3. CONNECTICUT TAX WITHHELD
3
<
4. CREDIT FROM PRIOR PERIOD
4
<
5. PAYMENTS MADE FOR THIS QUARTER
5
<
6. TOTAL DEPOSITS (Add Line 4 and Line 5)
6
<
7. NET TAX DUE (OR CREDIT) (Line 3 minus Line 6)
7
<
<
8a. PENALTY:
+ 8b. INTEREST:
= 8
<
9. AMOUNT APPLIED TO NEXT QUARTER
9
H
<
Check if you are a household employer.
10. AMOUNT TO BE REFUNDED
10
H
<
Check if you no longer have employees in Connecticut
11. TOTAL AMOUNT DUE (Add Line 7 and Line 8)
11
and enter date of last payroll: _____________________ .
I declare under the penalty of false statement that I have examined this return and, to the best of my knowledge and belief, it is true, complete, and correct. (The penalty for false statement
is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.)
Signature ________________________________________________________
Mail to:
DEPARTMENT OF REVENUE SERVICES
PO BOX 2931
HARTFORD CT 06104-2931
Title _______________________________________
Date _______________

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