Form Ct-1065/ct-1120si Ext - Application For Extension Of Time To File Connecticut Composite Income Tax Return - 2011

Department of Revenue Services

Form CT-1065/CT-1120SI EXT

2011

State of Connecticut

Application for Extension of Time to File

(Rev. 12/11)

Connecticut Composite Income Tax Return

See instructions on back before completing this form. Complete this form in blue or black ink only.

Visit to fi le and pay this return electronically.

Name of pass-through entity (PE)

Federal Employer Identifi cation Number (FEIN)



Taxpayer

Number and street

PO Box

DRS use only

Please

–

– 20



Type or

City or town

State

ZIP code

Connecticut Tax Registration Number

Print.



This is not an extension of time to pay your tax.

Payment must be included if any tax is due or interest and penalties may apply.

An extension granted by the Internal Revenue Service does not automatically extend the Connecticut fi ling date.

Type of PE







Electing large partnership (ELP)

General partnership (GP)

S corporation







Limited liability partnership (LLP)

Limited partnership (LP)

Partnership (LLC treated as a partnership)

I request a fi ve-month extension of time to September 15, 2012, to fi le Form CT-1065/CT-1120SI, Connecticut Composite Income Tax

Return, and the same extension of time to furnish Schedule CT K-1, Member’s Share of Certain Connecticut Items, to members for

calendar year 2011 or until ______________________________________ for taxable year ending



________________________ .

A federal extension has been requested on federal Form 7004, Application for an Automatic Extension of Time to File Certain Business

Income Tax, Information, and Other Returns, for calendar year 2011 or





taxable year beginning ___________________________ , 2011, and ending ___________________________ .

Yes

No

If No, the reason for the Connecticut extension is: ..................................................................................................................................................

..................................................................................................................................................................................................................................

..................................................................................................................................................................................................................................

Notifi cation will be sent only if the extension request is denied.

1. Reserved for future use ....................................................................................................... 1

2. Reserved for future use ....................................................................................................... 2

3. Connecticut composite income tax liability for 2011: You may estimate this amount.

An amount must be entered on Line 3. If no tax is due, enter zero “0.”

Pay in full with this form. ..................................................................................................

00



3

Visit the Department of Revenue Services (DRS) website at

to use the Taxpayer Service Center (TSC) to fi le and pay this return electronically.

To pay by mail: Make check payable to Commissioner of Revenue Services.

Write the PE’s FEIN and “2011 Form CT-1065/CT-1120SI EXT” on the check. DRS

may submit your check to your bank electronically. Mail form with payment to Department of Revenue

Services, State of Connecticut, PO Box 5019, Hartford CT 06102-5019. Mail form without payment

to Department of Revenue Services, State of Connecticut, PO Box 2967, Hartford CT 06104-2967.

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 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. The declaration of a paid preparer other than the

taxpayer is based on all information of which the preparer has any knowledge.

Signature of general partner or corporate offi cer

Title

Date

Telephone number

(

)

Sign Here

Paid preparer’s signature

Date

Preparer’s SSN or PTIN

Keep a copy

of this

Firm’s name and address

FEIN

return for

your records.

Telephone number

(

)