Form Ct-1041 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2005

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Department of Revenue Services
2005
Form CT-1041 EXT
State of Connecticut
(Rev. 12/05)
Application for Extension of Time to File
Connecticut Income Tax Return for Trusts and Estates
Important! Please read instructions on reverse before completing this application.
Name of Trust or Estate
Federal Employer Identification Number
Name and Title of Fiduciary
DRS Use Only
Taxpayer
– 20
(Please Type
Address of Fiduciary
Number and Street
PO Box
Decedent’s Social Security Number (For Estates Only)
• •
• •
or Print)
• •
• •
City, Town, or Post Office
State
ZIP Code
This is not an extension of time to pay your tax. You must include payment of any tax due or penalty and interest may apply (see
instructions). However, if you expect to owe no additional Connecticut income tax for the 2005 taxable year, after taking into account any
Connecticut income tax withheld or estimated Connecticut income tax payments you made, or both, and you requested an extension
of time to file your 2005 federal income tax return, you are not required to file Form CT-1041 EXT.
I request a six-month extension of time to October 15, 2006, to file my Connecticut Income Tax Return for Trusts and Estates for
calendar year 2005, or until ________________________ , _____ , for fiscal year ending
________________________ , _____ .
I have requested a federal extension on federal Form 7004, Application for 6-Month Extension of Time to File Certain Business Income
Tax, Information, and Other Returns, for calendar year 2005 or fiscal year beginning _______________________________ , _____
and ending ____________________________________ , ____________ .
Yes
No
If No, the reason for the Connecticut extension is _________________________________________________________________
_________________________________________________________________________________________________________
_______________________________________________________________________________________________
You will be notified only if your extension request is denied.
1. Total Connecticut income tax liability for 2005 (You may estimate this amount.)
00
An amount must be entered on Line 1. If you do not expect to owe income tax, enter
1
“0.” ................
00
2. Connecticut income tax withheld .............................................................................................................. 2
3. 2005 estimated Connecticut income tax payments including any 2004
00
overpayments credited to 2005 ................................................................................................................. 3
0
00
4. Add Line 2 and Line 3. ............................................................................................................................... 4
5. Connecticut income tax balance due (Subtract Line 4 from Line 1.) Pay in full with this form.
0
00
If Line 4 is greater than Line 1, enter
5
“0.” ......................................................................................................
Make check or money order payable to: Commissioner of Revenue Services. The Department of Revenue Services (DRS)
may submit your check to your bank electronically.
Write the Federal Employer Identification Number (FEIN) of the trust or estate and “2005 Form CT-1041 EXT” on the check or
money order.
Mail to:
Department of Revenue Services
PO Box 2934
Hartford CT 06104-2934
Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge
and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a fine of not more than $5,000, or imprisonment
for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Signature of Fiduciary or Officer Representing Fiduciary
Date
Telephone Number
(
)
Sign Here
Paid Preparer’s Signature
Date
Preparer’s PTIN or SSN
Keep a copy
of this
Firm’s Name and Address
Federal Employer Identification Number
form for
your records
Telephone Number
(
)

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