Form Apl-004 - Deposit In The Nature Of A Cash Bond - Connecticut Department Of Revenue
ADVERTISEMENT
1State of Connecticut
For DRS Use Only
Department of Revenue Services
FORM APL-004
450 Columbus Blvd Ste 1
Hartford CT 06103-1837
Deposit in the Nature of a Cash Bond
M M - D D - Y Y Y Y
Date of Deposit
(Rev. 05/17)
Taxpayers objecting to an assessment of tax owed to the State of Connecticut may make a remittance that is designated in
writing as a deposit in the nature of a cash bond. This limits the accrual of additional interest on the tax assessed, without
conceding liability for the assessment.
Form APL-004 is used to designate a remittance as a deposit in the nature of a cash bond. See Informational Publication
2017(10), Deposits in the Nature of a Cash Bond.
Part I - Taxpayer Information
Taxpayer’s Name
Social Security Number (If an Individual)
Address (Number and Street)
Connecticut Tax Registration No. (Business Only)
City, State, and ZIP Code
Federal Employer Identifi cation No. (Business Only)
Part II - Assessment and Remittance Information
1. Type of entity the taxpayer is:
Limited Liability Company
Limited Liability Partnership
Limited Partnership
General Partnership
Corporation
Sole Proprietorship
Trust
Estate
Individual
Other: ___________________________________________________________
2. Tax periods involved in the audit examination:
3. Tax type audited:
4. Revenue Examiner conducting audit examination:
5. Amount of remittance designated as a Deposit in the Nature of a Cash Bond:
.00
For additional assistance completing this form, call 860-297-4775, Monday through Friday, 8:00 a.m. to 4:30 p.m.
This form must be signed by:
•
A principal offi cer, if the taxpayer is a corporation or a limited liability company;
•
The general partner, if the taxpayer is a limited partnership or a limited liability partnership;
•
A partner, if the taxpayer is a general partnership;
•
The fi duciary, if the taxpayer is a trust or an estate; or
•
An individual or sole proprietor, if the taxpayer is an individual or sole proprietorship.
Part III - Signature
Taxpayer’s signature
Title
Date
Print taxpayer name
Print company name
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Apl-004 - Deposit In The Nature Of A Cash Bond - Connecticut Department Of Revenue Services
Financial
Form Rv-f1300601 - Affidavit To The Commissioner Of Revenue For The Purpose Of Filing An Application For A Certificate Of Title Without Payment Of Sales Or Use Tax
Financial
Form Cert-105 - Commercial Motor Vehicle Purchased Within Connecticut For Use Exclusively In The Carriage Of Freight In Interstate Commerce Certificate Form - Department Of Revenue Services, Connecticut
Business
Related Categories
Parent category: Financial