Department of Revenue Services
LGL-002
State of Connecticut
Request for Disclosure of
25 Sigourney Street
Hartford CT 06106-5032
Tax Return or Tax Return Information
RESET FORM
(Rev. 06/05)
Part 1 — Who Is Entitled to Make This Request?
• The sole proprietor, if the taxpayer is a sole proprietorship;
• A principal officer, if the taxpayer is a corporation (See Part 6
• A general partner, if the taxpayer is a partnership or a limited
below);
partnership;
• The successor, receiver, guarantor or assignee of the taxpayer;
• The administrator or executor, if the taxpayer is an estate;
• The authorized representative of any of the above; and
• The trustee, if the taxpayer is a trust;
• Any individual, if the request is for an income tax return filed by
• A member, if the taxpayer is a limited liability company that is not
that individual (or filed by that individual and his or her spouse if
managed by managers; or a manager, if the taxpayer is a limited
the request is for a joint income tax return). (Check the applicable
liability company that is managed by managers;
box in Part 2 and Part 3.)
Mail or hand-deliver this request to the address above, Attn: Director, Taxpayer Services Division. Please put the caption Request for
Tax Return or Tax Return Information on the envelope.
Part 2 — Whose Returns Are You Requesting?
Taxpayer Name
Social Security Number
Business Name
CT Tax Registration Number
Street Address
City
State
ZIP Code
Federal Employer ID Number
Taxpayer is: (Check box)
Corporation
Partnership
Sole Proprietorship
Trust (other than a business trust)
Estate
Individual
Limited Liability Company
Business Trust
Other (Specify.)
Part 3 — Information Requested:
(Copy of Return)
For Tax Periods:
Income Tax
Sales and Use Tax
Corporation Tax
Copy of Audit Workpapers
Account Reconciliation
(See instructions.)
Gift Tax
Other Return Type
Other (Specify.)
Part 4 — What Is Your Status?
Check a box
Sole Proprietor
Partner (Check box for partnership in
Guarantor (Attach guaranty.)
(Check box in Part 2.)
Part 2; attach partnership agreement.)
Receiver
Trustee (Check appropriate box for
Other (Specify.)
(Attach certificate of appointment.)
trusts in Part 2; attach trust agreement.)
Successor
Assignee
Individual
(Attach agreement.)
(Attach assignment.)
Authorized Representative
Executor or Administrator
Principal Officer (Check box for corporation
(Attach LGL-001, Power of Attorney.)
(Check box for estate in Part 2;
in Part 2; attach last annual report filed
attach Certificate of Appointment.)
with Secretary of the State.)
Member of a limited liability company that is not managed by managers
Manager of a limited liability company that is managed by managers.
(Check box for limited liability company in Part 2.)
(Check box for limited liability company in Part 2.)
Part 5 — What Is Your Name and Mailing Address?
Name of Person Making Request
Telephone Number
Email Address, if available
Street Address
City
State
ZIP Code
Part 6 — Declaration
I declare that if I am not the taxpayer identified above, I have been authorized by that taxpayer to execute this request on behalf of the taxpayer, and
I am permitted by the instructions on this form to make this request. (Attach LGL-001, Power of Attorney.)
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 to DRS is a fine of not more than
$5,000, or imprisonment for not more than five 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
Title
Date