Department of Revenue Services
Request for Issuance of a Ruling
25 Sigourney Street
Hartford CT 06106-5032
Social Security Number
Connecticut Tax Registration Number
Federal Employer Identiﬁ cation Number
1. Does this request involve a prospective (as opposed to a consummated) transaction?
2. Does this request involve an issue that is the same or similar to one:
A. Being considered by the Department of Revenue Services (DRS) in connection
with an audit examination of this taxpayer?
B. Being appealed to the Appellate Division of DRS by this taxpayer?
C. Being litigated in the Connecticut courts by this taxpayer?
D. Being considered by DRS in connection with a claim for refund made by this taxpayer?
3. Is this taxpayer undergoing an audit examination by DRS with respect to any issue or tax?
4. Has this taxpayer been notiﬁ ed concerning a pending audit examination by DRS with respect
to any issue or tax?
5. Does this request involve an issue that is clearly and adequately addressed by a statute,
regulation, or decision of the Connecticut or federal courts or by a declaratory ruling, ruling,
Special Notice, Policy Statement, or tax return instruction that has been issued by DRS?
6. Has this taxpayer previously been issued a ruling on the same or a similar issue by DRS?
If Yes, attach a copy of the ruling.
7. Has a representative been authorized to request the issuance of a ruling on behalf of this taxpayer?
If Yes, enter the name and address of the representative. The representative must be an individual
or individuals and may not sign declaration below.
8. Enter name and address to which the original ruling and other correspondence are to be mailed.
Only an individual having personal knowledge of the facts may sign the declaration below. An authorized representative may not sign the declaration.
If this taxpayer is a corporation, partnership, trust, or estate, the individual signing the declaration on behalf of the taxpayer must be a corporate
ofﬁ cer, general partner, or ﬁ duciary, as the case may be.
Declaration: I declare under penalty of law that I have examined this document (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 or imprisonment for not more than ﬁ ve years, or both.
Print or Type Name
Print or Type Title
The procedures that a taxpayer or authorized representative must comply with in requesting the issuance of a ruling and the procedures that
DRS follows in issuing a ruling are described in Policy Statement 2008(2), Requests for the Issuance of a Ruling. Visit the DRS website at
to preview and download forms and publications.