Form Reg-14 - Application For Commercial Fisherman Tax Exemption Permit
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Department of Revenue Services
Form REG-14
For Department Use Only
State of Connecticut
Application for Commercial Fisherman
Connecticut Tax Registration Number
25 Sigourney Street
Hartford CT 06106
Tax Exemption Permit
Rev. 04/07
Taxpayer Services Number
Conn. Gen. Stat. §12-412 (40)
Commercial Fisherman Tax Exemption Permit valid
from ________________ until ________________
Social Security Number (Individual)
Please correct
name and
— — — — — — — —
address
Federal Employer ID Number (Other)
if shown
incorrectly
at right.
Check One:
Check One:
Individual
New
Partnership
Renewal
Name of Vessel
Telephone Number
Business
Corporation
Structure
LLC
Changed
Home Port
LLP
Start-up
Fiduciary
DMV Vessel Registration
U.S. Coast Guard Documentation Number
DEP License Number
This certifies that:
•
At least 50% of last year’s gross income was derived from commercial fishing; or
•
On average, for the two preceding taxable years, at least 50% of your gross income was derived from commercial fishing.
Declaration: I declare under penalty of law that I have examined this application (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 statement to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Applicant’s Signature
Title
Date
Please complete this application and return it to: Department of Revenue Services
Taxpayer Services Division
25 Sigourney Street
Hartford CT 06106-5032
Enclose a copy of the applicant’s:
1. Federal income tax return and all accompanying schedules for the prior year; or
2. If you meet the 50% gross income requirement by using the average of the prior two years, federal income tax returns and all
accompanying schedules for the prior two years.
Form REG-14 should be completed and filed with the Department of Revenue Services (DRS) by June 1st so that DRS can make a
determination and issue a permit by the effective date. Your 2007 Fisherman Tax Exemption Permit is valid from July 1, 2007, until
June 30, 2009. If this application is submitted after June 1st, the permit is valid on the date indicated on the permit.
Start-up fisherman: The expiration date is 24 months from the date the permit is issued.
If you operate more than one vessel, attach a separate sheet listing the name, home port, Department of Motor Vehicles (DMV) vessel
registration and Department of Environmental Protection (DEP) license number for each vessel. If you are not a
Connecticut resident and are not required to have a DMV vessel registration or a DEP license number, leave these lines blank and
enter your U.S. Coast Guard documentation number.
For Information: Call DRS at 1-800-382-9463 (Connecticut calls outside the Greater Hartford Area only); or 860-297-5962 (from
anywhere) during business hours, Monday through Friday, 8:30 a.m. to 4:30 p.m. TTY, TDD, and Text Telephone users only may
transmit inquiries anytime by calling 860-297-4911. See Informational Publication 2007(13), Fisherman’s Guide to Sales and Use
Taxes and Estimated Income Tax, for more information.
For Department Use Only
Commissioner’s
Approved
Authorized Agent
______________________________________________________________
Disapproved
Title
_________________________________________
Date ______________
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