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Department of Revenue Services

2011

Form CT-1096 ATHEN

State of Connecticut

Connecticut Annual Summary and

PO Box 5081

Hartford, CT 06102-5081

Transmittal of Information Returns

(Rev. 02/11)

General Instructions

Round down to the next lowest dollar all amounts that include 1

through 49 cents. Round up to the next highest dollar all amounts

Complete this return in blue or black ink only.

that include 50 through 99 cents. However, if you need to add

If you are required to ﬁ le federal Form 1096, Annual Summary

two or more amounts to compute the amount to enter on a line,

and Transmittal of U.S. Information Returns, you are required

include cents and round off only the total.

to ﬁ le this form.

Example: Add two amounts ($1.29 + $3.21) to compute the

Form CT-1096 ATHEN may be used by new payers or payers

total ($4.50) to enter on a line. $4.50 is rounded to $5.00 and

who have not received the Designated Withholding Agent’s

entered on the line.

Withholding Remittance Package for Income Tax Withholding

Line Instructions

for Athletes and Entertainers for 2011.

Line 1

See Policy Statement 2009(1), Income Tax Withholding for

Athletes and Entertainers.

Enter Connecticut income tax withheld from payments made

to athletes or entertainers during the 2011 calendar year. This

Complete Form CT-1096 ATHEN and ﬁ le it with copy 1 of all

should equal the Total line on the back of this return. For federal

federal Forms 1099-MISC, Miscellaneous Income, reporting

Form 1042-S ﬁ lers, this is the sum of Connecticut income tax

Connecticut income tax withholding information in Boxes 16

withholding reported on federal Form 1042-S, Box 23.

and 18. See Special Rules for Payments Made to Nonresident

Aliens for ﬁ ling instructions for federal Form 1042-S, Foreign

Line 2

Person’s U.S. Source Income Subject to Withholding.

Enter total payments made to athletes or entertainers during

the 2011 calendar year. This should equal the sum of payments

Special Rules for Payments Made to Nonresident

subject to Connecticut income tax withholding reported on

Aliens

each federal Form 1099-MISC, Box 18, or each federal

If you made payments to athletes or entertainers who were

Form 1042-S, Box 2, to the extent derived from services

nonresident aliens, or any other persons considered foreign

performed in Connecticut.

persons under the instructions for federal Form 1042-S

Line 3

and were required to issue a federal Form 1042-S, complete a

Enter the number of federal Forms 1099-MISC or 1042-S

separate Form CT-1096 ATHEN and ﬁ le it with a copy of each

submitted with this return.

federal Form 1042-S reporting Connecticut income tax withheld.

Complete all required information on the front and back of this

Rounding Off to Whole Dollars

return. Sign and date the return in the space provided.

You must round off cents to the nearest whole dollar on your

Do not make a payment with this return. Payments

returns and schedules. If you do not round, the Department of

must be made using Form CT-8109 (DRS), Connecticut

Revenue Services (DRS) will disregard the cents.

Withholding Tax Payment Form for Nonpayroll Amounts,

Form CT-945 ATHEN, Connecticut Annual Reconciliation

of Withholding for Nonpayroll Amounts, or Form CT-941X,

Amended Connecticut Reconciliation of Withholding.



Separate here and mail return to DRS. Make a copy for your records.

2011

CT-1096 ATHEN

Connecticut Annual Summary and Transmittal of Information Return



Connecticut Tax Registration Number

Federal Employer ID Number

Due date

February 29, 2012



Enter name and address below. Please print or type.

1. Connecticut income tax withheld from

 1.

Name

Connecticut nonpayroll amounts

2. Total nonpayroll amounts reported with

 2.

Form CT-1096 ATHEN

Address

3. Number of 1099 or 1042-S submitted  3.

I declare under penalty of law that I have examined this return (including any

City

State

ZIP code

accompanying schedules and statements) and, to the best of my knowledge

and belief, it is true, complete, and correct. I understand the penalty for willfully

delivering a false return or document to DRS is a ﬁ ne of not more than $5,000,

imprisonment for not more than ﬁ ve years, or both.

Do not send a payment with this return.

Mail to:

Department of Revenue Services

Signature _____________________________________________________________

State of Connecticut

PO Box 5081

Hartford CT 06102-5081

Title _____________________________________ Date ____________________

Form Ct-1096 Athen - Connecticut Annual Summary And Transmittal Of Information Returns - 2011

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