Fillable Form Op-186 - Connecticut Individual Use Tax Return printable pdf download

State of Connecticut

Department of Revenue Services

For Calendar Year

____

PO Box 2973

Hartford CT 06104-2973

Connecticut Individual Use Tax Return

(Rev. 11/98)

For the year January 1 -

December 31, 19 ___

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

• •

__ __ __

__ __

__ __ __ __

• •

Home Address

Number and Street

City, Town or Post Office

State

ZIP Code

Use this form to report purchases of goods or services subject to Connecticut use tax for any calendar year. You may use this form to

report either a single transaction or multiple transactions for the same calendar year. (Instead of using this form, you may use Line 15 on

Line 7 on

to report your use tax.)

Enter your name and social security number at the top of this form, and if applicable, your spouse’s name and social security number. You may

file either a separate or a joint return regardless of your filing status for income tax purposes.

Enter the last 2 digits of the calendar year for which you are filing this return. You may file more than one form for a given year but do not

combine transactions for different years.

Column 5 - Multiply the purchase price in Column 4 by 6% (.06)

Column 1 - Enter the month, day and year of the purchases.

or the applicable rate, and enter the result.

Column 2 - Enter a brief description of taxable items or services

Column 6 - Enter the tax, if any, paid to another jurisdiction on

purchased, such as jewelry, a boat, etc.

the taxable item purchased.

Column 3 - Enter the name of the retailer from whom the item

Column 7 - Subtract the amount entered in Column 6 from the

or service was purchased.

amount entered in Column 5 and enter the

Column 4 - Enter the purchase price.

difference in Column 7. Total Amount Due (If less

than zero, enter 0, and do not file this form).

Column 1

Column 2

Column 3

Column 4

Column 5

Column 6

Column 7

Date of

Description of

Retailer or

Purchase

CT Tax Due

Tax Paid

Balance Due

to Another

(Col. 5 minus Col. 6

Purchase

Articles or Services

Service Provider

Price

(.06 X Col. 4)

Jurisdiction

but not less than zero)

If no use tax is due, you are not required to file a use tax return.

See Question 14, on the back of this form for information about tax rates on certain services.

Total Tax

PENALTY: FOR FAILURE TO PAY TAX WHEN DUE - 10% (.10) of the tax due.

Penalty

INTEREST: FOR LATE PAYMENT - 1% (.01) of tax due per month, or fraction thereof, from due date.

Interest

Total Amount Due

Check one of the following, whichever applies:

This return represents all purchases subject to use tax made during the calendar year listed above.

This return represents one of the following:

A single taxable purchase made during the calendar year listed above;

Multiple taxable purchases made through a date prior to the end of the calendar year listed above;

A subsequent return for the calendar year listed above for items not previously reported.

Please Note: Do not mail this return with your income tax return. A separate check must accompany this return.

Due Date: This return may be filed at the time of purchase, but not later than April 15 for purchases made during the preceding calendar year.

Do not file this return if use tax was already paid on a motor vehicle, vessel, or aircraft upon registration.

Make check or money order payable to: Commissioner of Revenue Services.

Write your Social Security Number and “19___ Individual Use Tax” on your check or money order.

Mail this return with check or money order to: Department of Revenue Services, PO Box 2973, Hartford CT 06104-2973.

Declaration: I declare under the penalty of false statement that I have examined this return (including any accompanying schedules and statements)

and, to the best of my knowledge and belief, it is true, complete and correct. Declaration of preparer (other than taxpayer) is based on all information

of which preparer has any knowledge.

Your Signature

Date

Spouse’s Signature

Date

Paid Preparer’s Signature

Date

Federal Employer ID Number

Keep a copy

for your

Firm Name and Address

records

Form Op-186 - Connecticut Individual Use Tax Return

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