Form Ct-1120 Ext - Application For Extension Of Time To File Corporation Business Tax Return - 2012

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Form CT-1120 EXT
Department of Revenue Services
2012
State of Connecticut
Application for Extension of Time to File
PO Box 2974
Corporation Business Tax Return
Hartford CT 06104-2974
Complete this form in blue or black ink only. See instructions on reverse.
(Rev. 12/12)
Enter Income Year Beginning
____________________________, 2012, and Ending
__________________________, ____________
Corporation name
CT Tax Registration Number
Taxpayer
Number and street
PO Box
DRS use only
Please
– 20
type
City or town
State
ZIP code
Federal Employer ID Number (FEIN)
or print.
Request for Six-Month Extension to File Form CT-1120, Form CT-1120CR, or Form CT-1120U
Each corporation must submit payment of any tax due or believed to be due with this application for an extension of time to file, whether or not
an application for federal extension has been approved. See instructions on reverse.
I request a six-month extension of time, to October 1, 2013, to file a Connecticut Corporation Business Tax Return for calendar year 2012 or
until ________________________ for fiscal year ending ________________________.
A federal extension has been requested on federal Form 7004, Application for Automatic Extension of Time to File Certain Business Income Tax,
Information, and Other Returns, for calendar year 2012, or for fiscal year beginning _____________________, 2012, and
ending_______________________.
Yes
No
If No, the reason for the Connecticut extension is ______________________________________________________________________________
_____________________________________________________________________________________________________________________
Are you filing Form CT-1120CR?
Are you filing Form CT-1120U?
Yes
No
Yes
No
Tentative Return
00
1. Tentative amount of tax due for this income year; minimum tax $250. See instructions. .................................
1.
2. Surtax: See instructions. ..................................................................................................................................
2.
00
00
3. Total tax: Add Line 1 and Line 2. Include tax credit recapture, if applicable. ...................................................
3.
4. Multiply Line 3 by 30% (.30) or see instructions.. .............................................
4.
00
5. Multiply the number of companies included by $250. ........................................
5.
00
6. Enter the greater of Line 4 or Line 5. ................................................................................................................
6.
00
00
7. Tax credit limitation: Subtract Line 6 from Line 3. .............................................................................................
7.
00
8. Tax credits: Do not exceed amount on Line 7. ..............................................................................................
8.
00
9. Balance of tax payable: Subtract Line 8 from Line 3. .......................................................................................
9.
00
10. Payment(s) of estimated tax .............................................................................. 10.
00
11. Overpayment from prior year .............................................................................
11.
12. Total payments: Add Line 10 and Line 11. ........................................................................................................
12.
00
13. Balance due with this return: Subtract Line 12 from Line 9. .........................................................................
13.
00
Mail paper return with payment to:
Mail paper return without payment to:
Department of Revenue Services
Department of Revenue Services
Visit the DRS Taxpayer Service Center (TSC)
State of Connecticut, PO Box 2974
State of Connecticut, PO Box 150406
at to file and pay this return
Hartford CT 06104-2974
Hartford CT 06115-0406
electronically.
Make check payable to Commissioner of
Revenue Services.
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 the Department of Revenue
Services (DRS) is a fine of not more than $5,000, 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.
Corporate officer’s name (print)
Corporate officer’s signature
Date
May DRS contact the preparer
Sign Here
shown below about this return?
Title
Telephone number
Yes
No
Keep a
(
)
See instructions.
copy
of this
Paid preparer’s name (print)
Paid preparer’s signature
Date
Preparer’s SSN or PTIN
return for
your
Firm’s name and address
FEIN
Telephone number
records.
(
)

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