Form Ct-6559 - Transmitter Report For Form W-2 Magnetic Media Filing - State Of Connecticut
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1
2STATE OF CONNECTICUT
CT-6559
DEPARTMENT OF REVENUE SERVICES
PO Box 2930
Hartford CT 06104-2930
TRANSMITTER REPORT
for Form W-2 Magnetic Media Filing
NOTE: This form must be accompanied by Form CT-W3(s)
1. Type of file represented by this transmittal
2. Calendar year for which media is submitted
3. Transmitter’s Connecticut Tax Registration Number
Original
Replacement
4. Name and address of transmitter (Include street, PO box, city, state and ZIP code)
5. Transmitter’s Federal Employer Identification Number
6. Name and address of person to contact about this magnetic media file
7. Contact telephone number (include area code)
(
)
8. Type of media submitted
9. Total number of media in shipment
Magnetic Tape
Cartridge
Diskette
10. Total number of employers
11. Total number of employees
12. Transmitter’s magnetic media inventory numbers
(In general, the employer must sign the declaration; however, an authorized agent of the employer may sign if all conditions stated on the back are met.)
I declare under the penalties of false statement that I have examined this report and, to the best of my knowledge and belief, it is true, complete and correct.
_______________________________________________________________________________________________________________________________
Signature
Title
Date
13. Employer Summary of Form W-2 Magnetic Media Wage Information
13. Employer Summary of Form W-2 Magnetic Media Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
Zip
City
State
Zip
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Total Connecticut Amount of Form W-2 Fields
Total Connecticut Amount of Form W-2 Fields
Number of W-2s Submitted
Number of W-2s Submitted
Total Connecticut Wages Reported
Total Connecticut Wages Reported
Connecticut Tax Withheld From Wages
Connecticut Tax Withheld From Wages
13. Employer Summary of Form W-2 Magnetic Media Wage Information
13. Employer Summary of Form W-2 Magnetic Media Wage Information
Name of Employer
Name of Employer
Street address
Street address
City
State
Zip
City
State
Zip
Connecticut Tax Registration Number
Connecticut Tax Registration Number
Federal Employer ID Number
Federal Employer ID Number
Total Connecticut Amount of Form W-2 Fields
Total Connecticut Amount of Form W-2 Fields
Number of W-2s Submitted
Number of W-2s Submitted
Total Connecticut Wages Reported
Total Connecticut Wages Reported
Connecticut Tax Withheld From Wages
Connecticut Tax Withheld From Wages
(Rev. 10/98)
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