Form Ct-1041 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2009

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Department of Revenue Services
Form CT-1041 EXT
2009
State of Connecticut
Application for Extension of Time to File
(Rev. 12/09)
Connecticut Income Tax Return for Trusts and Estates
Complete this form in blue or black ink only. Read instructions on reverse before completing this application.
Name of trust or estate
Federal Employer Identifi cation Number (FEIN)
Name and
Name and title of fi duciary
DRS use only
Address
– 20
Address of fi duciary
Number and street
PO Box
Decedent’s Social Security Number (SSN): For estates only
Please type
• •
• •
• •
• •
or print.
City, town, or post offi ce
State
ZIP code
Electronically fi le Form CT-1041 EXT
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 2009 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 fi le your 2009 federal income tax return, you are not required to fi le Form CT-1041 EXT.
I request a fi ve-month extension of time to September 15, 2010, to fi le my Connecticut income tax return for trusts and estates for
calendar year 2009 or until __________________________, _____ , for fi scal year ending
________________________ , ______ .
I have requested a federal extension on federal Form 7004, Application for Automatic Extension of Time to File Certain Business Income
Tax, Information, and Other Returns, for calendar year 2009 or fi scal year beginning _________________________________ , _____
and ending _____________________________________ , _______ .
Yes
No
____________________________________________________________
If No, the reason for the Connecticut extension is
________________________________________________________________________________________________
You will be notifi ed only if your extension request is denied.
1. Total Connecticut income tax liability for 2009: 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. 2009 estimated Connecticut income tax payments including any 2008
00
overpayments credited to 2009 ..................................................................................................................... 3
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.
00
If Line 4 is greater than Line 1, enter
5
“0.” .............................................................................................................
Visit the Department of Revenue Services (DRS) Taxpayer Service Center (TSC) website at to electronically fi le your return
and to make a direct tax payment or to download and print the return.
Pay by Mail: Make check payable to: Commissioner of Revenue Services. To ensure payment is applied to your account, write the FEIN of
the trust or estate and “2009 Form CT-1041 EXT” on the front of the check. The DRS may submit your check to your bank electronically.
Mail paper return and check to: Department of Revenue Services, State of Connecticut, 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 fi ne of not more than $5,000, or
imprisonment for not more than fi ve 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 fi duciary or offi cer representing fi duciary
Date
Telephone number
Sign Here
(
)
Paid preparer’s signature
Date
Preparer’s Tax Identifi cation Number (PTIN) or SSN
Keep a copy
of this
Firm’s name and address
Firm’s FEIN
form for
your records.
Telephone number

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