Form Ct-8809 - Request For Extension Of Time To File Informational Returns printable pdf download

Department of Revenue Services

Form CT-8809

State of Connecticut

PO Box 2930

Request for Extension of Time to

Hartford CT 06104-2930

File Informational Returns

(Rev. 01/12)

(For Forms W-2, W-2G, 1099-R, and 1099-MISC)

Complete this form in blue or black ink only. See instructions on reverse.

1. Filer or transmitter name and mailing address (number and street including room

2. Connecticut Tax Registration Number

or suite number, or PO Box, city, state, and ZIP code)

Extension

Request

for

3. Federal Employer Identification Number (FEIN)

Calendar

Year

4. Person to be contacted about this request

5. Telephone number

201__

(

)

6. Check the boxes that apply. You need not enter the number of returns.

Media Type

W-2

W-2G

1099-R

1099-MISC

Electronic

Paper

7. Has an extension of time to file federal informational returns been requested from the Internal Revenue Service (IRS)?

Yes

(If Yes, attach a copy of federal Form 8809, Application for Extension of Time to File

Informational Returns.)

If Yes, was the request for extension approved?

Yes

Pending

(If Yes, attach a copy of the extension request approval.)

8. State in detail why you need an extension. If more space is required, attach additional page(s).

____________________________________________________________________________________________________________________

9. Will you provide, or have you provided, a copy of the informational return or the required statement to the recipient on time?

Yes

Declaration: I declare under the 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, 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