Form 472 - Attorney Occupational Tax Return - 2013
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32013
Form 472
Department of Revenue Services
State of Connecticut
Attorney Occupational Tax Return
PO Box 5031
Hartford CT 06102-5031
Complete this return in blue or black ink only.
Rev.(11/13)
Due Date: For 2013, Form 472 must be fi led on or before January 15, 2014, by all attorneys listed on the roll of attorneys maintained
by the Superior Court at any time during calendar year 2013. Visit the Department of Revenue Services (DRS) website at
to use the Taxpayer Service Center (TSC) to fi le and pay this return electronically.
Connecticut Tax Registration Number
Social Security Number (SSN)
Please
correct
Juris Number
your name
and
Received by DRS
address if
shown
incorrectly.
Check if this is an amended return.
Check if address has changed.
Section I - Exemptions
If you claim exemption from the occupational tax for calendar
year 2013,
please check one of the following boxes. If more than one
statement is true, check the primary reason you are exempt from the tax. If you are not exempt from the tax, skip to Section II, Line 1.
Check one:
The attorney named above died during calendar year
2013. Enter date of death
_______________________________________
My name was removed from the roll of attorneys maintained
by the Clerk of the Superior Court for the Judicial District of Hartford.
I engaged in the practice of law, but not as an occupation, and I received less than
$1000
in compensation from engaging in the practice
of law.
I was a judge, senior judge, or referee. (Probate judges who otherwise engage in the practice of law cannot claim this exemption.)
I was a Connecticut state employee employed as an attorney and I did not otherwise engage in the practice of law.
I was a federal government employee employed as an attorney and I did not otherwise engage in the practice of law.
I was a Connecticut political subdivision employee employed as an attorney and did not otherwise engage in the practice of law.
I was a Connecticut probate court employee employed as an attorney and did not otherwise engage in the practice of law.
I engaged in the practice of law exclusively outside of Connecticut.
I did not work or was not employed as an attorney.
I was on active duty with the United States Armed Forces for more than six months.
I retired from the practice of law and fi led written notice of retirement with the Clerk of the Superior Court for the Judicial District
of Hartford.
Section II - Tax Computation
$565 00
1
Occupational tax
1
00
2
Penalty: See page 2.
2
00
3
Interest: See page 2.
3
00
4
Total amount due: Add Lines 1, 2, and 3.
4
Visit to fi le and pay this return electronically.
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
DRS
is a fi ne of not more
than $5,000, or imprisonment for not more than fi ve 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 of attorney
Title
Date
Sign Here
Print name of principal offi cer
Telephone number
Keep a copy
(
)
of this return
Paid preparer’s signature
Date
Preparer’s Tax Identifi cation Number (PTIN) or SSN
for your
records.
Firm’s name and address
Federal Employer Identifi cation Number (FEIN)
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