Form Ct-1041 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2001

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2001
FORM CT-1041 EXT
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
Application for Extension of Time to File
CT-1041 EXT
(Rev. 12/01)
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
FOR DEPARTMENT 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 IF ANY TAX DUE OR PENALTY AND INTEREST MAY APPLY (SEE INSTRUCTIONS)
AN EXTENSION GRANTED BY THE INTERNAL REVENUE SERVICE DOES NOT AUTOMATICALLY EXTEND THE CONNECTICUT FILING DATE
I request a six-month extension of time to October 15, 2002, to file my Connecticut Income Tax Return for Trusts and Estates
for calendar year 2001, or until ______________________ , _____ , for fiscal year ending
_________________________ , ______ .
I have requested a federal extension on either federal Form 2758, Application for Extension of Time to File Certain Excise, Income, Information, and
Other Returns , or federal Form 8736, Application for Automatic Extension of Time to File U.S. Return for a Partnership, REMIC, or for Certain Trusts,
for calendar year 2001 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 2001 (You may estimate this amount) ................................... 1
Note: An amount must be entered on Line 1. If you do not expect to owe income tax, enter
“0.”
2. Connecticut income tax withheld .................................................................................................................. 2
3. 2001 estimated Connecticut income tax payments including any 2000
overpayments credited to 2001 ..................................................................................................................... 3
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.
If Line 4 is greater than Line 1, enter
5
“0.” .........................................................................................................
COMMISSIONER OF REVENUE SERVICES.
Make check or money order payable to:
Write the Federal Employer Identification Number of the trust or estate and “2001 Form CT-1041 EXT” on the check or money order.
Department of Revenue Services
Mail to:
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 that the penalty for willfully delivering a false return 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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