Form Ct-1040 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Individuals - 2010

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Department of Revenue Services
2010
Form CT-1040 EXT
State of Connecticut
Application for Extension of Time to File
(Rev. 12/10)
Print Form
Reset Form
EXT
Connecticut Income Tax Return for Individuals
See the instructions before you complete this form. Complete this form in blue or black ink only.
Your fi rst name and middle initial
Last name
Your Social Security Number (SSN)
• •
• •
• •
• •
Spouse’s Social Security Number
If a joint return, spouse’s fi rst name and middle initial
Last name
• •
• •
• •
• •
Please type
Important!
or print.
Home address (number and street), apartment number, PO box
You must enter your SSN(s) above.
Daytime telephone number
(
)
City, town, or post offi ce
State
ZIP code
DRS use only
– 20
This is not an extension of time to pay your tax.
To request an extension of time to pay, fi le Form CT-1127,
Application for Extension of Time for Payment of Income Tax.
You must fi le this form by the due date of your original return or your request will be denied. See instructions. However, if you expect
to owe no additional Connecticut income tax for the 2010 taxable year, after taking into account any Connecticut income tax
withheld from your wages or any estimated Connecticut income tax payments you have made, or both, and you have requested
an extension of time to fi le your 2010 federal income tax return, you are not required to fi le Form CT-1040 EXT. You will be
subject to interest and may be subject to a penalty on any amount of tax not paid on or before the original due date of your return.
I request a six-month extension of time to October 15, 2011, to fi le my Connecticut income tax return for the year beginning
January 1, 2010, and ending December 31, 2010.
If you are not a calendar year taxpayer, complete the following statement:
I request a six-month extension of time to ____________________________ , to fi le my Connecticut income tax return for the
year beginning _____________________________ and ending
_____________________________ .
I have requested a federal extension on federal Form 4868, Application for Automatic Extension of Time to File U.S. Individual
Income Tax Return, for taxable year 2010.
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 income tax liability for 2010
00
You must enter an amount on Line 1. If you do not expect to owe income tax, enter “0.” ........1.
2. Total individual use tax liability for 2010
00
You must enter an amount on Line 2. If you do not expect to owe use tax, enter “0.” ..............2.
00
3. Add Line 1 and Line 2. ...............................................................................................................3.
00
4. Connecticut income tax withheld: Do not attach W-2s or 1099s ....4.
5. 2010 estimated Connecticut income tax payments including any
00
2009 overpayments applied to 2010 ................................................5.
00
6. Add Line 4 and Line 5 . ..............................................................................................................6.
7. Connecticut income tax and use tax balance due: Subtract Line 6 from Line 3.
If Line 6 is greater than Line 3, enter “0.” Amount due with this form ................................ 
00
7.
Forms with payment, mail to:
Forms without payment:
Department of Revenue Services
Department of Revenue Services
PO Box 2977
PO Box 2976
Hartford CT 06104-2977
Hartford CT 06104-2976
Make your check payable to:
Do not mail this return if you do not
Commissioner of Revenue Services
owe any tax and you have requested
To ensure proper posting, write your SSN (optional) and
an extension of time to fi le your 2010
“2010 Form CT-1040 EXT” on your check.
federal income tax return.

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