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2003

STATE OF CONNECTICUT

FORM CT-1096 (DRS)

DEPARTMENT OF REVENUE SERVICES

(Rev. 12/02)

CONNECTICUT ANNUAL SUMMARY AND TRANSMITTAL OF INFORMATION RETURNS

PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING THIS RETURN

Purpose: The attached Form CT-1096 (DRS), Connecticut Annual

– federal Form 1099-MISC, for payments to resident individuals, or to

Summary and Transmittal of Information Returns , may be used by new

nonresident individuals, if the payments relate to services performed wholly

payers or payers who have not received the Employer’s Withholding

or partly in Connecticut, even if no Connecticut income tax was withheld;

Remittance Coupon Book for 2003.

– federal Form 1099-R, only if Connecticut income tax was withheld;

Annual Reconciliation: Form CT-1096 must be filed by certain payers

– federal Form 1099-S, reporting real estate transactions in Connecticut.

who are required to file federal Form 1096. Form CT-1096 is due the last

day of February. No payment is to be made with this return.

Group the forms by form number and send each group with a

separate Form CT-1096.

If you are required to file federal Form 1096, you must file Form CT-1096.

If you are not required to file federal Form 1096, you are not required to file

Attach every “state copy” of the following:

Form CT-1096.

– federal Form W-2G, for (1) Connecticut Lottery winnings paid to resident

The above federal forms must be filed with the Connecticut Department of

and nonresident individuals, even if no Connecticut income tax was

Revenue Services even if you are not required to be registered with DRS.

withheld, and (2) other gambling winnings paid to resident individuals,

Unregistered filers should write “Information Only” in the space reserved

even if no Connecticut income tax was withheld;

for the Connecticut Tax Registration Number on this return.

– federal Form 1098, for property taxes paid on real estate to a Connecticut

Mail your completed return to: Department of Revenue Services,

municipality;

PO Box 5081, Hartford CT 06102-5081.

2003

CT-1096 (DRS) CONNECTICUT ANNUAL SUMMARY AND TRANSMITTAL OF INFORMATION RETURNS

CONNECTICUT TAX REGISTRATION NUMBER

FEDERAL EMPLOYER ID NUMBER

DUE DATE

1. Connecticut income tax withheld from

Enter name and address below. Please print or type.

nonpayroll amounts (See instructions)

2. Total nonpayroll amounts reported with

Form CT-1096 (See instructions)

1 2 3 4 5

3. Number of 1098s, 1099s, and W-2Gs

1 2 3 4 5

submitted

1 2 3 4 5

NOTE: DO NOT SEND A PAYMENT WITH THIS RETURN.

TAXPAYER’S COPY

MAIL TO:

DEPARTMENT OF REVENUE SERVICES

PO BOX 5081

HARTFORD CT 06102-5081

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 that the penalty for willfully delivering a false return to DRS is a fine

of not more than $5,000, or imprisonment for not more than five years, or both.

Signature __________________________________________________________

Title ______________________________________ Date __________________

SEPARATE HERE AND MAIL COUPON TO DEPARTMENT OF REVENUE SERVICES. KEEP THE TOP PORTION FOR YOUR RECORDS.

2003

CT-1096 (DRS) CONNECTICUT ANNUAL SUMMARY AND TRANSMITTAL OF INFORMATION RETURNS

CONNECTICUT TAX REGISTRATION NUMBER

FEDERAL EMPLOYER ID NUMBER

DUE DATE

1. Connecticut income tax withheld from

Enter name and address below. Please print or type.

nonpayroll amounts (See instructions)

2. Total nonpayroll amounts reported with

Form CT-1096 (See instructions)

1 2 3 4 5

3. Number of 1098s, 1099s, and W-2Gs

1 2 3 4 5

submitted

1 2 3 4 5

NOTE: DO NOT SEND A PAYMENT WITH THIS RETURN.

MAIL TO:

DEPARTMENT OF REVENUE SERVICES

PO BOX 5081

HARTFORD CT 06102-5081

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 that the penalty for willfully delivering a false return to DRS is a fine

of not more than $5,000, or imprisonment for not more than five years, or both.

Signature __________________________________________________________

Title ______________________________________ Date __________________

Form Ct-1096 (Drs) - Connecticut Annual Summary And Transmittal Of Information Returns - 2003

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