Form Ct-4804 Instructions - 2007
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1Form CT-4804
Instructions
Complete this form in blue or black ink only. Use Form
Use Form CT- 4802, Transmittal of Informational Returns
CT-4804, Transmittal of Informational Returns Reported on
Reported on CD (Continuation), if you are reporting for more
CD, to identify the transmitter of a CD file. All requested
than four payers.
information must be entered on Form CT-4804.
Substitute Forms CT- 4804 and CT- 4802: DRS encourages
the use of computer-generated substitutes for Forms CT- 4804
Include Form CT-1096, Connecticut Annual Summary and
and CT-4802. The format must include all information
Transmittal of Information Returns, only if Connecticut tax was
requested on these forms including the declaration. (See
withheld.
Declaration Requirements below.)
Specific Instructions
Declaration Requirements
Block 1:
Indicate whether the data in this shipment is an
original or replacement file by checking the
An agent who is a transmitter, service bureau, paying agent,
appropriate box.
or disbursing agent may sign Form CT- 4804 on behalf of the
payer (or other person required to file), if both conditions below
Block 2:
Enter the calendar year for which the CD files are
are met:
being submitted.
1. The agent has the authority to sign the form under an agency
Block 3:
Enter the transmitter’s Federal Employer
agreement (oral, written, or implied) that is valid under state
Identification Number (FEIN).
law; and
Block 4:
Enter the name of the transmitter. (See Declaration
2. The agent signs the form and adds the caption “For: (Name
Requirements at right.)
of payer or other person required to file).”
Block 5:
Enter the name and address of the company along
with the name and title of the person to contact
The authorized agent’s signing of the declaration on the payer’s
about problem files. Also enter the telephone
behalf does not relieve the payer of the responsibility for filing
number.
a correct, complete, and timely Form CT-4804, with
attachments, and does not relieve the payer of any penalties
Block 6:
Indicate the type of file being submitted.
for not complying with those requirements.
Block 7:
Enter the total number of CDs included in your
Forms and Publications
shipment.
Forms and publications are available anytime by:
Block 8:
Enter the combined total number of payee records
being reported.
•
Internet: Visit the DRS website at
to download and print Connecticut tax forms; or
Block 9:
For each payer, enter the name, address,
Connecticut Tax Registration Number, FEIN,
•
Telephone: Call 1-800-382-9463 (Connecticut calls
type of return (1098, 1099-R, 1099-MISC, or
outside the Greater Hartford calling area only) and select
W-2G), the number of payee records, total
Option 2 from a touchtone phone; or call 860-297-4753
nonpayroll amounts from Connecticut sources
(from anywhere).
reported, and Connecticut tax withheld.
TTY, TDD, and Text Telephone users only may transmit
Only one type of return should be entered on a
inquiries anytime by calling 860-297-4911.
payer summary. Types of returns must not be
intermingled.
Mailing Address: Send your CDs in the same package with
transmittal Forms CT- 4804 and CT- 4802 to the address below.
Department of Revenue Services
State of Connecticut
PO Box 5081
Hartford CT 06102-5081
If a PO Box cannot be used, send to:
Department of Revenue Services
State of Connecticut
Attn: Processing II, 15th Floor
25 Sigourney Street
Hartford CT 06106-5032
Form CT- 4804 Back (Rev. 12/07)
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