Form Ct-8109 (Drs) - Connecticut Withholding Tax Payment Form For Nonpayroll Amounts - 2012
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1
22012
Department of Revenue Services
Form CT-8109 (DRS)
State of Connecticut
PO Box 2931
Connecticut Withholding Tax
Hartford, CT 06104-2931
Payment Form for Nonpayroll Amounts
(Rev. 12/11)
Complete this form in blue or black ink only.
General Instructions
Line Instructions
Form CT-8109 (DRS) may be used by new payers or payers who
Enter name, address, and identifi cation numbers.
have not received their 2012 Connecticut Payer of Nonpayroll
Line 1: Enter the number of the quarter to which this payment
Amounts Withholding Returns and Instructions (TPG-172).
applies. Enter 1 for the 1st quarter (January 1 through
Once the withholding book is received, use only the preprinted
March 31), 2 for the 2nd quarter (April 1 through June 30), 3 for
coupons in that book.
the 3rd quarter (July 1 through September 30), or 4 for the 4th
All payers of nonpayroll amounts subject to Connecticut income
quarter (October 1 through December 31).
tax withholding are required to withhold Connecticut income tax
If the tax liability was incurred during one quarter and paid to DRS
at the time payments of nonpayroll amounts are made.
in another quarter, enter the quarter in which the tax liability was
incurred. For example, if the tax liability was incurred in March
See Informational Publication 2012(8), Connecticut Tax Guide
and paid to DRS in April, enter 1.
for Payers of Nonpayroll Amounts.
Line 2: Enter total Connecticut income tax withheld from
Use Form CT-8109 (DRS) to make your withholding tax
nonpayroll amounts.
payments to the Department of Revenue Services (DRS). See
back of form for nonpayroll amounts subject to withholding.
How to File
Payment Frequency
Do not fi le Form CT-8109 (DRS) if no payment is due or
payment was made by electronic funds transfer (EFT).
Each calendar year DRS classifi es payers for Connecticut
income tax withholding purposes as a weekly, monthly, or
Use the Taxpayer Service Center (TSC) to electronically fi le
quarterly remitter. Most new payers will be classifi ed as quarterly
and pay the amount on Line 2. See Taxpayer Service Center
remitters.
(TSC) on back.
The payment frequency is based on the payer’s reported
To pay by mail, make your check payable to Commissioner of
withholding tax liability for the look-back calendar year. The
Revenue Services. Write your Connecticut Tax Registration
look-back calendar year for calendar year 2012 is calendar year
Number and the calendar quarter to which the payment applies
2010. See Special Notice 2004(10), 2004 Legislation Affecting
on your check. DRS may submit your check to your bank
Connecticut Income Tax Withholding by Payers From Nonpayroll
electronically. Mail the completed form and payment to:
Amounts Paid on or After January 1, 2005, and the Connecticut
Department of Revenue Services
Withholding Tax Payment Schedule on back.
State of Connecticut
Weekly and monthly remitters are required to fi le and pay
PO Box 2931
electronically if notified by DRS. Quarterly remitters are
Hartford CT 06104-2931
encouraged to fi le and pay electronically.
Do not fi le Form CT-8109 (DRS) if no payment is due.
Separate here and mail coupon to DRS. Make a copy for your records.
2012
CT-8109 (DRS)
Connecticut Withholding Tax Payment Form for Nonpayroll Amounts
Connecticut Tax Registration Number
Federal Employer ID Number
Year
2012
1. Enter quarter (1, 2, 3, or 4).
Enter name and address below. Please print or type.
See instructions.
Name
2. Connecticut tax withheld
• File electronically at
Address
• Do not fi le Form CT-8109 (DRS) if no payment is due.
• Pay amount on Line 2.
• If fi ling by mail, send payment to:
DRS, PO Box 2931, Hartford CT 06104-2931
City
State
Zip code
• Make check payable to
Commissioner of Revenue Services.
• Write your Connecticut Tax Registration Number
on your check.
DO NOT FOLD OR BEND COUPON
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