Form Ct-1040 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Individuals - 2004

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2004
Form CT-1040 EXT
State of Connecticut
Department of Revenue Services
EXT
Application for Extension of Time to File
Connecticut Income Tax Return for Individuals
– See Instructions Before Completing This Form –
Your First Name and Middle Initial
Last Name
Your Social Security Number
__ __ __
__ __
__ __ __ __
• •
• •
• •
• •
Spouse’s Social Security Number
If a JOINT Return, Spouse’s First Name and Middle Initial
Last Name
__ __ __
__ __
__ __ __ __
• •
• •
TAXPAYER
• •
• •
IMPORTANT!
(Please Type
Home Address (number and street), Apartment Number, PO Box
You must enter your SSN(s) above.
or Print)
Daytime Telephone Number
(
)
City, Town, or Post Office
State
ZIP Code
DRS USE ONLY
– 20
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-1040 EXT (see instructions on reverse).
This is not an extension of time to pay your tax.
You must file this form by the due date of your original return or your request will be denied (see instructions). However, if you do not
expect to owe additional Connecticut income tax for the 2004 taxable year, after taking into account Connecticut income tax withheld
from your wages or estimated Connecticut income tax payments you have made (or both), and you have requested an extension of
time to file your 2004 federal income tax return, you are not required to file Form CT-1040 EXT. You will be subject to interest and
may be subject to a penalty on any amount of tax that is not paid on or before the original due date of your return.
I request a six-month extension of time to October 15, 2005, to file my Connecticut income tax return for the year beginning
January 1, 2004, and ending December 31, 2004.
If you are not a calendar year taxpayer, complete the following statement:
,
I request a six-month extension of time to _________________________________ to file 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 2004.
YES
NO
If NO, the reason for the Connecticut extension is ____________________________________________________________________
_____________________________________________________________________________________________________________
– YOU WILL BE NOTIFIED ONLY IF YOUR EXTENSION REQUEST IS DENIED –
Total income tax liability for 2004.
1.
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 2004.
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.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
00
4. Connecticut income tax withheld (Do not attach W-2s or 1099s.) ...... 4.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
5. 2004 estimated Connecticut income tax payments including any
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
00
2003 overpayments applied to 2004 ....................................................... 5.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
00
6. Add Line 4 and Line 5 .............................................................................................................................. 6.
7. Connecticut income tax and use tax balance due. Subtract Line 6 from Line 3.
00
If Line 6 is greater than Line 3, enter “0.” Amount due with this form. ..........................................
7.
Forms with payment mail to:
Forms without payment mail to:
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 or money order payable to:
“Commissioner of Revenue Services”
To ensure proper posting, write your SSN(s) and
“2004 Form CT-1040 EXT” on your check or money order.

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