Form Au-764 - Deposit By A Person Doing Business With A Nonresident Contractor

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Department of Revenue Services
Form AU-764
For Period Ending
Discovery Unit
Deposit by a Person Doing Business
25 Sigourney Street
Hartford CT 06106-5032
Due Date
With a Nonresident Contractor
(Rev. 03/06)
Total Amount Remitted
For Department Use Only
Purpose: A person doing business with a nonresident contractor files Form AU-764 with the Department of Revenue Services (DRS) to
deposit 5% of all payment(s) made to a nonresident contractor during the calendar quarter for each project in the state.
If you need help, call 860-541-3280, Monday through Friday, 8:30 a.m. to 4:30 p.m., and choose Option 7.
Person Doing Business With a Nonresident Contractor
Name
Connecticut Tax Registration Number
Address (Street or PO Box, City, State, and ZIP Code)
Federal Employer Identification Number
Project Information
Physical Location of Project #1 (Street, City or Town)
Name of Project
Nonresident Contractor(s) Information
Name of Nonresident Contractor #1
Connecticut Tax Registration Number
Address (Street or PO Box, City, State, and ZIP Code)
Federal Employer Identification Number
Commencement Date for Completion Date for
Total Contract Price or Amount of Change Order
Total Payments This Quarter
Nonresident Contractor
Nonresident Contractor
Amount of Deposit This Quarter
Check the box if this deposit is for a change order
Name of Nonresident Contractor #2
Connecticut Tax Registration Number
Address (Street or PO Box, City, State, and ZIP Code)
Federal Employer Identification Number
Commencement Date for Completion Date for
Total Contract Price or Amount of Change Order
Total Payments This Quarter
Nonresident Contractor
Nonresident Contractor
Amount of Deposit This Quarter
Check the box if this deposit is for a change order
Name of Nonresident Contractor #3
Connecticut Tax Registration Number
Address (Street or PO Box, City, State, and ZIP Code)
Federal Employer Identification Number
Commencement Date for Completion Date for
Total Contract Price or Amount of Change Order
Total Payments This Quarter
Nonresident Contractor
Nonresident Contractor
Amount of Deposit This Quarter
Check the box if this deposit is for a change order

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