Form Ct-1040 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Individuals - 1998

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STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

IMPORTANT! PLEASE READ INSTRUCTIONS ON REVERSE BEFORE COMPLETING THIS APPLICATION

Your First Name and Middle Initial

Last Name

Your Social Security Number

__ __ __

__ __

__ __ __ __

If a JOINT Return, Spouse’s First Name and Middle Initial

Last Name

Spouse’s Social Security Number

__ __ __

__ __

__ __ __ __

(Please Type

Home Address

Number and Street

DEPARTMENT USE ONLY

or Print)

City, Town or Post Office

State

ZIP Code

Your Telephone Number

(See Instructions)

I request a

of time to

to file my Connecticut Income Tax Return for calendar year 1998 or

until __________________________________ for fiscal year 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 Calendar Year 1998 .

YES

, the reason for the Connecticut extension is ___________________________________________________________________________

______________________________________________________________________________________________________________________

YOU WILL BE NOTIFIED ONLY IF YOUR EXTENSION REQUEST IS DENIED

Total income tax liability for 1998 (You may estimate this amount)

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 1998. (You may estimate this amount)

You must enter an amount on Line 2. If you do not expect to owe use tax, enter 0 .............................. 2.

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

4. Connecticut income tax withheld (Do not attach W2s 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

5. 1998 estimated Connecticut income tax payments including any 1997

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2

overpayments credited to 1998 ....................................................................... 5.

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2

6. Add Line 4 and Line 5 ..................................................................................................................................... 6.

7. Connecticut income tax and use tax balance due. (Subtract Line 6 from Line 3)

If Line 6 is greater than Line 3, enter 0. Amount due with this form ...................................................

Remember to include your name(s), mailing address and social security number(s) at the top of this form.

Make your check or money order payable to: COMMISSIONER OF REVENUE SERVICES

Write your Social Security Number(s) and “1998 Form CT-1040 EXT” on your check or money order.

Mail to:

Department of Revenue Services

PO Box 2977

Hartford CT 06104-2977