Form Au-960 - Nonresident Contractor Request For Verified Contractor Status printable pdf download

Form Au-960 - Nonresident Contractor Request For Verified Contractor Status

Department of Revenue Services

Compliance Support Unit

25 Sigourney Street, Ste. 2

Hartford CT 06106-5032

(New 10/01/2011)

Form AU-960

Nonresident Contractor

Request for Verified Contractor Status

Purpose: A nonresident contractor uses Form AU-960 to request “Verified Contractor” status for a two-year period

beginning January 1

of the requested year and ending December 31

of the following year. Verified contractors are not

subject to the 5% holdback provisions under Conn. Gen. Stat. §12-430(7).

For assistance, call 860-541-7538, Monday

through Friday, during business hours.

Part I: Nonresident Contractor Information

Name

Connecticut Tax Registration No.

Address (Street or PO Box, City, State, and ZIP Code)

Type of Organization:

Limited liability company (LLC)

Corporation

Sole proprietorship

Single member LLC (SMLLC)

S Corporation

Other (explain):

Part II: Verification Period

(Two-year Period)

January 1, 20__ __

through

December 31, 20__ __

Part III:

Person Doing Business with Nonresident Contractor, if applicable

Name

Project Name

Commencement Date

Contract Dollar Amount

Part IV: Conditions



Is registered for all applicable taxes with DRS,



Has filed all required tax returns with DRS,



Has no outstanding tax liabilities with DRS, AND

Has been registered for all applicable taxes with DRS for three years and is current with filings and payment; OR

If the three year registration requirement is not met then the contractor needs to complete Form AU-961,

Verification Bond, and submit it with this form.

Nonresident Contractor Declaration: I, an authorized agent of the nonresident contractor named above, declare under

the penalty of law that I have examined Form AU-960 and, to the best of my knowledge and belief it is true, complete, and

correct. I understand the penalty for willfully delivering a false document or return to DRS is a fine of not more than

$5,000, or imprisonment for not more than five years, or both.

Nonresident Contractor:

Print Name

Title

Signature

Date

Form AU-960

Page

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Form Au-960 - Nonresident Contractor Request For Verified Contractor Status

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