Form Ct-W3 (Drs) - Connecticut Annual Reconciliation Of Withholding - 2003
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22003
FORM CT-W3 (DRS)
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
CONNECTICUT ANNUAL RECONCILIATION OF WITHHOLDING
(Rev. 12/02)
Purpose:
The attached Form CT-W3 (DRS), Connecticut Annual
Send with Form CT-W3 every “state copy” of federal Form W-2 reporting Connecticut
Reconciliation of Withholding , may be used by new employers or employers
wages paid during the calendar year (Copy 1 of the optional six-part federal Form
who have not received the Employer’s Withholding Remittance Coupon
W-2 or equivalent). If you are required by the IRS to file copies of federal Form
Book for 2003.
W-2 on magnetic media, you must file these forms on magnetic media with DRS.
Annual Reconciliation: Form CT-W3 is due the last day of February.
However, if you file 24 or fewer W-2 forms with DRS, you may be excused from
the magnetic media filing requirements without obtaining a waiver. For new
No payment is to be made with this return. Employers must file every “state
information regarding magnetic media reporting requirements, visit the DRS Web
copy” of federal Form W-2 with the annual reconciliation, even if no Connecticut
site at: or call DRS at: 1-800-382-9463 (in-state) or
income tax was withheld.
860-297-5962 (from anywhere). TTY, TDD, and Text Telephone users only may
INSTRUCTIONS FOR COMPLETING THE ANNUAL
transmit inquiries by calling 860-297-4911.
RECONCILIATION OF WITHHOLDING - Form CT-W3
Household employers: If a household employer is not registered with
Line 1: Enter the total amount of Connecticut income tax withheld from wages
DRS for Connecticut income tax withholding purposes, the employer should
for the entire calendar year. This should equal the Total Line on the
enter the words “HOUSEHOLD EMPLOYER” in the space reserved for the
back of this return.
Connecticut Tax Registration Number on this return.
Line 2: Enter the gross Connecticut wages paid during the calendar year.
Agricultural employers:
If an agricultural employer is not registered
Line 3: Indicate the number of W-2 forms submitted with this return.
with DRS for Connecticut income tax withholding purposes, the employer
Be sure to complete all requested information on the back of this return. Sign
should write the words “AGRICULTURAL EMPLOYER” in the space reserved
and date the return in the space provided.
for the Connecticut Tax Registration Number on this return.
Do not send a payment with this return. All payments must be made
Mail your completed return to: Department of Revenue Services, PO Box 2930,
using Forms CT-WH and CT-941.
Hartford CT 06104-2930.
CT-W3 (DRS) CONNECTICUT ANNUAL RECONCILIATION OF WITHHOLDING
2003
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
DUE DATE
1. Connecticut tax withheld from wages
Enter name and address below. Please print or type.
(See instructions)
1.
2. Total Connecticut wages reported
2.
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
3. Number of W-2s submitted
3.
1 2 3 4 5
TAXPAYER’S COPY
NOTE: DO NOT SEND A PAYMENT WITH THIS RETURN.
DEPARTMENT OF REVENUE SERVICES
PO BOX 2930
HARTFORD CT 06104-2930
Check if you are a household employer and
you withhold Connecticut income tax from the
I declare under penalty of law that I have examined this return (including any accompanying
wages of household employees.
schedules and statements) and, to the best of my knowledge and belief, it is true, complete,
and correct. I understand that the penalty for willfully delivering a false return to DRS is a fine
Check if you are a household employer and
of not more than $5,000, or imprisonment for not more than five years, or both.
you do not withhold Connecticut income tax
from the wages of household employees.
Signature __________________________________________________________
Title ______________________________________ Date __________________
SEPARATE HERE AND MAIL COUPON TO DEPARTMENT OF REVENUE SERVICES. KEEP THE TOP PORTION FOR YOUR RECORDS.
CT-W3 (DRS) CONNECTICUT ANNUAL RECONCILIATION OF WITHHOLDING
2003
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
DUE DATE
1. Connecticut tax withheld from wages
Enter name and address below. Please print or type.
(See instructions)
1.
2. Total Connecticut wages reported
2.
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
3. Number of W-2s submitted
3.
1 2 3 4 5
1 2 3 4 5
NOTE: DO NOT SEND A PAYMENT WITH THIS RETURN.
DEPARTMENT OF REVENUE SERVICES
PO BOX 2930
HARTFORD CT 06104-2930
Check if you are a household employer and
you withhold Connecticut income tax from the
I declare under penalty of law that I have examined this return (including any accompanying
wages of household employees.
schedules and statements) and, to the best of my knowledge and belief, it is true, complete,
and correct. I understand that the penalty for willfully delivering a false return to DRS is a fine
Check if you are a household employer and
of not more than $5,000, or imprisonment for not more than five years, or both.
you do not withhold Connecticut income tax
from the wages of household employees.
Signature __________________________________________________________
Title ______________________________________ Date __________________
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