Form Ct-941 (Drs) - Connecticut Quarterly Reconciliation Of Withholding - 2003

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2003
FORM CT-941 (DRS)
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
(Rev. 12/02)
Purpose: The attached Form CT-941 (DRS), Connecticut Quarterly
Seasonal filers must obtain permission from DRS to file for only
Reconciliation of Withholding, may be used by new employers who
the quarters in which they are active. Annual filers who withhold
have not received the Employer’s Withholding Remittance Coupon
Connecticut income tax from nonpayroll amounts only must obtain
Book for 2003.
permission from DRS to file only for the fourth quarter. Household
employers who voluntarily register with DRS may request annual
All employers registered for Connecticut income tax withholding
filing. See Informational Publication 2000 (11), Connecticut Circular
are required to file Form CT-941. You must file a quarterly
CT - Employer’s Tax Guide, for detailed information on how to obtain
reconciliation as long as you have an active withholding account
permission to become a seasonal or annual filer.
with the Department of Revenue Services (DRS), even if no tax
is due, or if no tax was required to be withheld for that quarter. In
Be sure to complete all requested information on the back of this
general, Form CT-941 must be filed even if you are not required to
return. See instructions on back. Sign and date the return in the
file federal Form 941 (for example: household employers,
space provided. If payment is due, remit payment with this return.
agricultural employers, payers of nonpayroll amounts, and
Make your check payable to: COMMISSIONER OF REVENUE
intermittent filers).
SERVICES. Write your Connecticut Tax Registration Number, and
Due dates: First quarter, April 30, 2003; second quarter,
the calendar quarter to which the payment applies, on your check.
July 31, 2003; third quarter, October 31, 2003; and fourth quarter,
Mail your completed return and payment (if applicable) to: Department
January 31, 2004. An employer who made full and timely payments of
of Revenue Services, PO Box 2931, Hartford CT 06104-2931.
all income tax withholding for the quarter, may file the return by the 10th
day of the second calendar month following the end of the quarter. If
To a m e n d F o r m C T - 9 4 1 , u s e F o r m C T - 9 4 1 X , Amended
you are a household employer and permitted by DRS to file one return
Connecticut Quarterly Reconciliation of Withholding. Forms
annually, the due date of Form CT-941 is April 15, 2004.
and publications may be obtained by visiting the DRS Web
If the due date falls on a Saturday, Sunday, or legal holiday, the
site at: or by calling the DRS Forms Unit
next business day is the due date.
at: 860-297-4753.
CT-941 (DRS)
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
2003
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
ENTER REPORTING QUARTER (1, 2, 3, OR 4) DUE DATE
READ INSTRUCTIONS BEFORE COMPLETING
Did you know that you can file this return by
1. GROSS WAGES AND NONPAYROLL AMOUNTS
1
2. GROSS CT WAGES AND NONPAYROLL AMOUNTS
2
Internet or
Internet or
Internet or T T T T T elephone?
elephone?
elephone?
elephone?
Internet or
Internet or
elephone?
3. CONNECTICUT TAX WITHHELD
3
See back page for information.
4. CREDIT FROM PRIOR PERIOD
4
5. PAYMENTS MADE FOR THIS QUARTER
5
TAXPAYER’S COPY
6. TOTAL DEPOSITS (Add Line 4 and Line 5)
6
7. NET TAX DUE (OR CREDIT) (Line 3 minus Line 6)
7
8a. PENALTY:
+ 8b. INTEREST:
= 8
Check if you are a household employer.
9. AMOUNT APPLIED TO NEXT QUARTER
9
Check if you no longer have employees in Connecticut
10. AMOUNT TO BE REFUNDED
10
and enter date of last payroll: _____________________ .
11. TOTAL AMOUNT DUE (Add Line 7 and Line 8)
11
I declare under penalty of law 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.
Signature ________________________________________________________
Title ____________________________________________ Date ___________
SEPARATE HERE AND MAIL COUPON TO DEPARTMENT OF REVENUE SERVICES. KEEP THE TOP PORTION FOR YOUR RECORDS.
CT-941 (DRS)
CONNECTICUT QUARTERLY RECONCILIATION OF WITHHOLDING
2003
CONNECTICUT TAX REGISTRATION NUMBER
FEDERAL EMPLOYER ID NUMBER
ENTER REPORTING QUARTER (1, 2, 3, OR 4) DUE DATE
READ INSTRUCTIONS BEFORE COMPLETING
1. GROSS WAGES AND NONPAYROLL AMOUNTS
1
ENTER NAME AND ADDRESS BELOW. PLEASE PRINT OR TYPE.
2. GROSS CT WAGES AND NONPAYROLL AMOUNTS
2
3. CONNECTICUT TAX WITHHELD
3
4. CREDIT FROM PRIOR PERIOD
4
5. PAYMENTS MADE FOR THIS QUARTER
5
6. TOTAL DEPOSITS (Add Line 4 and Line 5)
6
7. NET TAX DUE (OR CREDIT) (Line 3 minus Line 6)
7
8a. PENALTY:
+ 8b. INTEREST:
= 8
9. AMOUNT APPLIED TO NEXT QUARTER
9
Check if you are a household employer.
10. AMOUNT TO BE REFUNDED
10
Check if you no longer have employees in Connecticut
11. TOTAL AMOUNT DUE (Add Line 7 and Line 8)
11
and enter date of last payroll: _____________________ .
I declare under penalty of law 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.
Signature ________________________________________________________
Mail to:
DEPARTMENT OF REVENUE SERVICES
PO BOX 2931
HARTFORD CT 06104-2931
Title _______________________________________
Date _______________

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