Fillable Form Op-374 - Dry Cleaning Establishment Surcharge Return printable pdf download

Department of Revenue Services

OP-374

For Quarter Ending

State of Connecticut



PO Box 5018

Dry Cleaning Establishment

Connecticut Tax Registration Number

Hartford CT 06102-5018



Surcharge Return

(Rev. 04/11)

Federal Employer Identiﬁ cation Number



Due Date

Complete the return in blue or black ink only. You must ﬁ le a return each quarter even if

no surcharge is due. If you are permanently out of business, check the applicable box and

For DRS Use Only

enter your last day of business.

Check here if:



This is an amended return.

If the address



You are permanently out of business.

at right is

incorrect,

Enter the last business date:

please make

any changes



necessary.

You have a new address, trade name, or

physical location.

Enter new mailing address:



Enter new trade name:

Enter new physical location, not PO Box:

Total gross receipts from dry cleaning services



Total surcharge: Multiply Line 1 by 1% (.01).



Penalty:

See Line Instructions.



Interest: See Line Instructions.



Total amount due: Add Lines 2, 3, and 4.



General Instructions

For More Information: Call DRS during business hours, Monday

Due Date: On or before the last day of the month immediately

through Friday:

following the end of the calendar quarter.

•

1-800-382-9463 (Connecticut calls outside the Greater Hartford

Make your check payable to Commissioner of Revenue Services.

calling area only); or

Write your Connecticut Tax Registration Number on your check. The

Department of Revenue Services (DRS) may submit your check

•

860-297-5962 (from anywhere).

to your bank electronically.

TTY, TDD, and Text Telephone users only may transmit inquiries

Rounding: You must round off cents to the nearest whole dollar

anytime by calling 860-297-4911.

on your return schedules. If you do not round, DRS will disregard

Line Instructions

the cents. Round down to the next lowest dollar all amounts that

include 1 through 49 cents. Round up to the next highest dollar all

Line 3: Late Payment Penalty: If tax is due, the penalty for

amounts that include 50 through 99 cents.

underpayment of the surcharge is 10% of the surcharge due or

$50, whichever is greater.

New Owners: Do not use the previous owner’s form to ﬁ le your

return. Any change in ownership requires a new Connecticut Tax

Late Filing Penalty: The Commissioner of Revenue Services may

Registration Number.

impose a $50 penalty for the late ﬁ ling of any return or report that

is required by law to be ﬁ led.

Signature: You must sign the return.

Line 4: Interest: If this is a late or amended return, compute the

Pay Electronically: Visit to make a direct

interest at the rate of 1% per month or fraction of a month from the

tax payment. Using this option authorizes DRS to electronically

due date until the date of payment. Interest is based on the amount

withdraw a payment from your bank account (checking or savings)

that should have been remitted on time.

on a date you select up to the due date. If you pay electronically

you must still ﬁ le your return by the due date.

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.

Taxpayer’s Signature

Title

Date

Preparer’s Signature

Preparer’s Address

Date

Form Op-374 - Dry Cleaning Establishment Surcharge Return

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