Form Ct-Wh (Drs/n) - Connecticut Withholding Tax Payment Form - 2004
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12004
State of Connecticut
FORM CT-WH (DRS/N)
Department of Revenue Services
(Rev. 12/03)
CONNECTICUT WITHHOLDING TAX PAYMENT FORM
Pur pose: The attached Form CT-WH (DRS/N), Connecticut
only until the issuance of the Employer’s Withholding Remittance
Withholding Tax Payment Form , may be used by new employers
Coupon Book . Once the book is received, only the preprinted
or employers who have not received the Employer’s Withholding
coupons contained in the book should be used.
Remittance Coupon Book. This is an interim coupon to be used
EMPLOYER’S RECORD OF PAYMENT
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1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 0
1. ENTER QUARTER (1, 2, 3, or 4)
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1 2 3 4 5 6 7 8 9 0
(See instructions)
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1 2 3 4 5 6 7 8
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2. CONNECTICUT TAX
WITHHELD
Did you know you can file this r e t u r n b y
3. PAYMENT DATE:
Internet or
Internet or T T T T T elephone?
Internet or
elephone?
elephone?
Internet or
Internet or
elephone?
elephone?
S e e E l e c t r o n i c F i l i n g O p t i o n s b e l ow.
quarterly with Form CT- 941, Connecticut Quarterly Reconciliation of
All employers are required to withhold Connecticut income tax from
Withholding . Special rules apply for household employers. See Special
employee wages at the time wages are paid. Use Form CT-WH (DRS/N)
to make your payments to the Connecticut Department of Revenue
Notice 96(8), 1996 Legislative Changes Concerning “Nanny Tax”
Services (DRS). Due dates for payment of Connecticut withholding tax on
Withholding .
wages are the same as the due dates for the employer’s deposit of
This form is to be used by employers for payments of Connecticut
federal income tax withholding. Each time you are required to make a
withholding tax on wages only. Payers of nonpayroll amounts must use
federal tax deposit, you are required to mail a payment to DRS of all
Form CT- 8109, Connecticut Withholding Tax Payment Form for Nonpayroll
Connecticut income tax withheld. However, if your Connecticut withholding
Amounts .
Do not file Form CT-WH (DRS/N) if no payment is due.
tax liability is less than $500 for a calendar quarter, you may remit the tax
INSTRUCTIONS FOR COMPLETING FORM CT-WH (DRS/N)
Enter name, address, and identification numbers in appropriate
amount shown on Line 2. If you are filing Form CT-WH (DRS/N) by
boxes.
mail, send your completed coupon and payment to: DRS, PO Box
2931, Hartford CT 06104-2931. Make your check payable to:
Line 1:
COMMISSIONER OF REVENUE SERVICES. Write your
Connecticut Tax Registration Number, and the calendar quarter
Enter the number of the quarter to which this payment applies.
Enter “1” for the 1st quarter (January 1 to March 31); “2” for the 2nd
to which this payment applies, on your check.
quarter (April 1 to June 30); “3” for the 3rd quarter (July 1 to
Electronic Filing Options:
September 30); or “4” for the 4th quarter (October 1 to December 31).
File this form by using Connecticut Fast-File –
Note: If the tax liability was incurred during one quarter and paid to
File by Internet: or
DRS in another quarter, enter the number for the quarter in which
Telephone: 860-947-1988
the tax liability was incurred. For example, if the tax liability was
incurred in March and paid to DRS in April, enter “1” on Line 1 of
For information on the
Form CT-WH (DRS/N).
Connecticut Fast-File
Program, visit the DRS Web site
Line 2:
at and click on File
Returns On-Line , or call the DRS Forms Unit at 860-297- 4753
Enter the total amount of Connecticut income tax withheld from
and request DRS 2001(3), Connecticut Fast-File, booklet.
wages since your last payment was made to DRS. Pay the total
SEPARATE HERE AND MAIL COUPON TO DEPARTMENT OF REVENUE SERVICES. KEEP THE TOP PORTION FOR YOUR RECORDS.
CT-WH (DRS/N) CONNECTICUT WITHHOLDING TAX PAYMENT
2004
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
YEAR
2004
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
1. ENTER QUARTER (1, 2, 3, or 4)
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
ENTER NAME AND ADDRESS BELOW. PLEASE PRINT OR TYPE.
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
(See instructions)
1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1
2. CONNECTICUT TAX WITHHELD
Do not file this Form CT-WH (DRS/N) if no payment is due.
Pay total amount shown on Line 2.
If filing by mail, send your payment to:
DRS, PO Box 2931, Hartford CT 06104-2931
Make your check payable to: Commissioner of Revenue Services.
Write your Connecticut Tax Registration Number on your check.
Electronic Filing Options: Connecticut Fast-File
DO NOT FOLD OR BEND COUPON
File by Internet: or Telephone: 860-947-1988
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