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2000

FORM CT-1041 EXT

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

Application for Extension of Time to File

(Rev. 12/00)

CT-1041 EXT

Connecticut Income Tax Return for Trusts and Estates

IMPORTANT! PLEASE READ INSTRUCTIONS ON REVERSE BEFORE COMPLETING THIS APPLICATION

Name of Trust or Estate

Federal Employer Identification Number

Name and Title of Fiduciary

Date Received (FOR DEPARTMENT USE ONLY)

TAXPAYER

(Please Type

Address of Fiduciary

Number and Street

PO Box

Decedent’s Social Security Number (For Estates Only)

• •

or Print)

__ __ __

• •

__ __

• •

__ __ __ __

City or Town

State

ZIP Code

THIS IS NOT AN EXTENSION OF TIME TO PAY YOUR TAX

YOU MUST INCLUDE PAYMENT IF ANY TAX DUE OR PENALTY AND INTEREST MAY APPLY (SEE INSTRUCTIONS)

AN EXTENSION GRANTED BY THE INTERNAL REVENUE SERVICE DOES NOT AUTOMATICALLY EXTEND THE CONNECTICUT FILING DATE

I request a six-month extension of time to October 15, 2001, to file my Connecticut Income Tax Return for Trusts and Estates

for calendar year 2000, or until ______________________ , _____ , for fiscal year ending

________________________ , ______ .

I have requested a federal extension on either federal Form 2758, Application for Extension of Time to File Certain Excise, Income, Information, and

Other Returns , or federal Form 8736, Application for Automatic Extension of Time to File U.S. Return for a Partnership, REMIC, or for Certain Trusts,

for calendar year 2000 or fiscal year beginning ___________________ , _______ and ending ___________________ , ________ .

Yes

If No, the reason for the Connecticut extension is ______________________________________________________________________

__________________________________________________________________________________________________________________

YOU WILL BE NOTIFIED ONLY IF YOUR EXTENSION REQUEST IS DENIED.

1. Total Connecticut income tax liability for 2000 (You may estimate this amount) ................................... 1

Note: An amount must be entered on Line 1. If you do not expect to owe income tax, enter

“0.”

2. Connecticut income tax withheld .................................................................................................................. 2

3. 2000 estimated Connecticut income tax payments including any 1999

overpayments credited to 2000 ..................................................................................................................... 3

4. Add Line 2 and Line 3 .................................................................................................................................... 4

5. Connecticut income tax balance due (Subtract Line 4 from Line 1). Pay in full with this form.

If Line 4 is greater than Line 1, enter

“0.” ........................................................................................................

COMMISSIONER OF REVENUE SERVICES.

Make check or money order payable to:

Write the Federal Employer Identification Number of the trust or estate and “2000 Form CT-1041 EXT” on the check or money order.

Department of Revenue Services

Mail to:

PO Box 2934

Hartford CT 06104-2934

DECLARATION: I declare under the penalty of false statement that I have examined this application and, to the best of my knowledge and belief,

it is true, complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand