Form O-372 - Admissions, Dues And Cabaret Tax Return - Connecticut Department Of Revenue Services

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FOR PERIOD ENDED

O-372

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

ADMISSIONS, DUES AND CABARET TAX RETURN

P.O. Box 5031 Hartford CT 06102-5031

(Rev. 10/98)

1 Amount subject to admissions tax

CT TAX REGISTRATION NUMBER

2 Admissions tax due Multiply Line 1 by 10% (.10)

3 Amount subject to cabaret tax

4 Cabaret tax due Multiply Line 3 by 5% (.05 )

IMPORTANT

5 Amount subject to dues tax

Check here if:

6 Dues tax due

Multiply Line 5 by 10% (.10 )

Amended return

7 Total tax due (Add Line 2, Line 4 and Line 6)

Final return

8 Credits (Attach authorized credit memo)

(Enter last business day)

(Subtract Line 8

Adjusted tax

from Line 7)

If address at

right is

Interest

incorrect,

please make

Penalty

necessary

(Add Line 9, Line

Total due

changes.

10 and Line 11)

DECLARATION I declare under the penalties of false statement that I have examined this return and to the best of my knowledge and belief it is true, complete and correct.

SIGN

Taxpayer’s Signature

Title

Date

HERE