Form Au-330 - Controlling Interest Transfer Taxes
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4Department of Revenue Services
Form AU-330
State of Connecticut
PO Box 5031
Controlling Interest Transfer Taxes
Hartford CT 06102-5031
Read instructions before completing this return.
Part I - Transferor Information
1. Name and address of transferor
K
2. Social Security Number or Federal Employer ID Number of transferor
3. Connecticut Tax Registration Number (if any) of transferor
K
K
(If more than one transferor, attach a schedule providing the same information for all transferors.)
Part II - Transferee Information
1. Name and address of transferee
K
2. Social Security Number or Federal Employer ID Number of transferee
3. Connecticut Tax Registration Number (if any) of transferee
K
K
(If more than one transferee, attach a schedule providing the same information for all transferees.)
Part III - Transfer Information
1. Name and address of entity in which controlling interest was transferred
K
2. Federal Employer Identification Number of entity
3. Connecticut Tax Registration Number (if any) of entity
K
K
4. The entity is a(an)
G Corporation
G Limited Liability Company G Trust
G Partnership
G Other
K
5. Enter name of state under whose
6. Date of transfer of controlling
8. Was the controlling interest transfer made in a
7. Interest transferred on
series of transfers?
(If “Yes,” attach
interest in the entity
laws entity is organized
date indicated on Line 6
schedule describing earlier transfers)
G
G
K
K
K
K
Yes
No
Part IV - Computation of Amount Due and Payable
1.
Enter amount from Part V, Line 8
K
1.
2.
Interest due, if any, on amount on Line 1
K
2.
3.
Penalty due, if any, on amount on Line 1
K
3.
4.
Subtotal (add Lines 1, 2, and 3)
K
4.
5.
Enter amount from Part VI, Line 5
K
5.
6.
Enter amount from Part VII, Line 5
K
6.
7.
Subtotal (add Line 5 and Line 6)
K
7.
8.
Interest due, if any, on amount on Line 7
K
8.
9.
Penalty due, if any, on amount on Line 7
K
9.
10. Subtotal (add Lines 7, 8, and 9)
K
10.
11. Total amount due (add Line 4 and Line 10)
K
11.
Declaration: 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. I understand that the penalty for willfully delivering a false return to DRS is a fine of not
more than $5,000, or imprisonment for not more than five years, or both.
Signature
Title
Date
If more than one transferor, attach a declaration signed by each transferor.
Page 1 of 4
AU-330 (Rev. 9/03)
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