Form Reg-14 - Application For Commercial Fisherman Tax Exemption Permit - 2000
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1State of Connecticut
Department of Revenue Services
FORM REG-14
25 Sigourney Street
Hartford CT 06106
Application For
Commercial Fisherman Tax Exemption Permit
Rev. 02/00
For Department Use Only
Conn. Gen. Stat. §12-412 (40)
Permit Number
Taxpayer Services Number
Social Security Number ( Individual)
Please correct
<
Name and
— — — — — — — —
Address
Federal Employer ID Number (Other)
If shown
incorrectly
<
at right
Check One:
Check One:
~
~
Individual
New
~
~
Partnership
Renewal
Name of Vessel
Telephone Number
~
~
Corporation
Name
~
LLC
Change
1 2 3 4 5 6 7 8 9 0 1 2 3
~
Home Port
LLP
1 2 3 4 5 6 7 8 9 0 1 2 3
~
1 2 3 4 5 6 7 8 9 0 1 2 3
Fiduciary
1 2 3 4 5 6 7 8 9 0 1 2 3
DMV Vessel Registration
DEP License Number
This certifies that at least 50% of last year’s gross income was derived from commercial fishing.
Applicant’s Signature
Title
Date
Please complete this application and return to:
State of Connecticut
Department of Revenue Services
Taxpayer Services Division
25 Sigourney Street
Hartford, CT 06106-5032
Enclose a copy of the applicant’s prior year Federal Income Tax Return and all accompanying schedules.
Form REG-14 should be completed and filed with the Department of Revenue Services (DRS) by June 1st of each year so that
DRS can make a determination and issue a permit by the effective date. Your 2000 Fisherman Tax Exemption Permit will be
valid from July 1, 2000, until June 30, 2001. If this application is submitted after June 1st, the permit becomes valid on the date
indicated on the permit.
If you operate more than one vessel, attach a separate sheet listing the name, home port, DMV vessel registration, and DEP
license number for each vessel.
For Further Information: Call Taxpayer Services at 1-800-382-9463 (within Connecticut) or 860-297-5962 (from anywhere). TTY, TDD,
and Text Telephone users only may transmit inquiries 24 hours a day by calling 860-297-4911. See Policy Statement 93 (1.6),
Application Procedures for a Commercial Fisherman Exemption Permit , for additional information.
For Department Use Only
~
~
Approved
Disapproved
Commissioner’s
Authorized Agent _________________________________________________________
Title _________________________________________________________
Date _________________________________________________________
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