Form Au-764 - Deposit By A Person Doing Business With A Nonresident Contractor Page 2
ADVERTISEMENT
1
2
3Project Information
Physical Location of Project #2 (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
Conditions of the deposit for the project(s) detailed above:
•
The nonresident contractor has entered into a contract related to real property at a Connecticut location.
•
The person doing business with the nonresident contractor deposits 5% of the payments to the nonresident contractor
during the calendar quarter with DRS.
•
The deposit will be returned to the nonresident contractor upon written request by the contractor after DRS has examined
its records and determined all taxes, interest, and penalties due during the term of the contract have been paid.
•
The person doing business with the nonresident contractor must attach a copy of the final periodic billing to Form AU-764
if this deposit is the final payment to the nonresident contractor for this project.
Declaration: I, an authorized agent of the person doing business with the nonresident contractor named above, declare under
penalty of law that I have examined Form AU-764 and, to the best of my knowledge and belief it is true, complete, and correct.
I understand the penalty for willfully delivering a false document or return to DRS is a fine of not more than $5,000, or imprisonment
for not more than five years, or both.
Print Name
Title
Authorized Signature
Date
Form AU-764 Page 2 (Rev. 03/06)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Mbca-12 - Application For Authority To Do Business For A Foreign Business Corporation - 2016
Legal
Form St-137rv - Affi Davit Of Exemption By A Nonresident Of Indiana On The Purchase Of A Recreational Vehicle Or Cargo Trailer
Financial
Form Cert-139 - Sales And Use Tax Exemption For A Vessel Purchased By A Nonresident Of Connecticut - Department Of Revenue Services - State Of Connecticut
Financial
Form Cert-125 - Sales And Use Tax Exemption For A Motor Vehicle Purchased By A Nonresident Of Connecticut - Department Of Revenue Services - State Of Connecticut
Financial
Form St-137 - Affidavit Of Exemption By A Nonresident On The Purchase Of A Recreational Vehicle/cargo Trailer Form - Indiana Department Of Revenue
Legal
Related Categories
Parent category: Financial