Form Ct-6559 - Submitter Report For Form W-2 Compact Disc (Cd) Filing

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Department of Revenue Services
Form CT-6559
State of Connecticut
Submitter Report
PO Box 2930
Hartford CT 06104-2930
for Form W-2 Compact Disc (CD) Filing
(Rev. 01/12)
Complete this form in blue or black ink only.
1.
File type
2. Calendar year reported on CDs
3. Submitter’s Connecticut Tax Registration Number
Original
Replacement
4.
Submitter’s Federal Employer ID Number (FEIN) 5. Number of CDs shipped
6. Number of employers
7. Number of employees
8.
Submitter name
Street address
City
State
ZIP code
9.
Person to contact if there is a problem processing the CD
Name
Title
Telephone number
(
)
10. Employer summary of W-2 forms reported on CD. Complete for each employer submitted.
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
$
Total Connecticut wages reported
Total Connecticut wages reported
$
$
Connecticut tax withheld from wages
Connecticut tax withheld from wages
Employer name
Employer name
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Connecticut Tax Registration Number
Connecticut Tax Registration Number
FEIN
No. of W-2s submitted
FEIN
No. of W-2s submitted
$
$
Total Connecticut wages reported
Total Connecticut wages reported
$
$
Connecticut tax withheld from wages
Connecticut tax withheld from wages
See Declaration Requirements on back.
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

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