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Department of Revenue Services

2009

PO Box 5081

Hartford, CT 06102-5081

Form CT-1096 (DRS)

(Rev. 01/09)

Connecticut Annual Summary and Transmittal of Information Returns

Electronic Filing Requirements - Read instructions on back before completing this form.

General Instructions

Line Instructions

Complete the return in blue or black ink only.

Line 1: Enter the total amount of income tax withheld from

Connecticut nonpayroll amounts subject to Connecticut income

Form CT-1096 (DRS), Connecticut Annual Summary and Transmittal

tax withholding during the calendar year. (This should equal the

of Information Returns, may be used by new payers or payers who

Total line on the back of this return.) Nonpayroll amounts subject

have not received the Withholding Remittance Coupon Book for

to Connecticut income tax withholding are the amounts required to

Payers of Nonpayroll Amounts for 2009.

be reported on Line 2.

See Informational Publication 2009(8), Connecticut Tax Guide for

Line 2: Enter the total amount of:

Payers of Nonpayroll Amounts.

• Connecticut Lottery winnings paid to resident and nonresident

Annual Summary

individuals, as reported on federal Form W-2G, whether or not

If ﬁ ling electronically, Form CT-1096 (DRS) is due the last day

Connecticut income tax was withheld;

of March, 2010, and will be completed as part of the electronic

• Other gambling winnings paid to resident individuals, as reported

ﬁ ling process. Do not mail in Form CT-1096 (DRS) if you are ﬁ ling

on federal Form W-2G, whether or not Connecticut income tax

electronically. If ﬁ ling by paper, Form CT-1096 (DRS) is due the

was withheld;

last day of February, 2010. No payment is to be made with this

• Miscellaneous payments made to resident individuals, or, where

return. If the due date falls on a Saturday, Sunday, or legal holiday,

the payments relate to services performed wholly or partly within

the next business day is the due date. See back page for Who Must

Connecticut, to nonresident individuals, as reported on federal

File Form CT-1096 (DRS).

Form 1099-MISC, whether or not Connecticut income tax was

Rounding Off to Whole Dollars

withheld; and

You must round off cents to the nearest whole dollar on your returns

• Distributions from pensions, annuities, retirement, or

and schedules. If you do not round, DRS will disregard the cents.

proﬁ t-sharing plans, as reported on federal Form 1099-R, but

only if Connecticut income tax was withheld.

Round down to the next lowest dollar all amounts that include

1 through 49 cents. Round up to the next highest dollar all amounts

Group the forms by form number and send each group with a

that include 50 through 99 cents. However, if you need to add two

separate Form CT-1096 (DRS).

or more amounts to compute the amount to enter on a line, include

Line 3: Indicate the number of 1099-MISC, 1099-R, and

cents and round off only the total.

W-2G forms submitted with this return. Be sure to complete all

Example: Add two amounts ($1.29 + $3.21) to compute the total

required information on the back of this return.

($4.50) to enter on a line. $4.50 is rounded to $5.00 and entered

on the line.

Where to File

I f ﬁ ling by paper, mail your completed return to:

Department of Revenue Services

PO Box 5081

Hartford CT 06102-5081

Separate here and mail coupon to DRS. Make a copy for your records.

2009

CT-1096 (DRS)

Connecticut Annual Summary and Transmittal of Information Returns

Connecticut Tax Registration Number

Federal Employer ID Number

Calendar Year Ending

Due Date

February 28, 2010

Enter name and address below. Please print or type.

1. Connecticut income tax withheld from

Name

Connecticut nonpayroll amounts

2. Total nonpayroll amounts reported with

Form CT-1096

Address

3. Number of 1099-MISC, 1099-R, or W-2Gs

submitted

City

State

ZIP Code

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

Note: Do not send a payment with this return.

imprisonment for not more than ﬁ ve years, or both.

Mail to:

Department of Revenue Services

Signature _____________________________________________________________

PO Box 5081

Hartford CT 06102-5081

Title _____________________________________ Date ____________________

Form Ct-1096 (Drs) - Connecticut Annual Summary And Transmittal Of Information Returns - 2009

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