Form Ct-8809 - Request For Extension Of Time To File Informational Returns
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1Department of Revenue Services
State of Connecticut
Form CT-8809
PO Box 2930
Hartford CT 06104-2930
Request for Extension of Time to
(Rev. 10/04)
File Informational Returns
(For Forms W-2, W-2G, 1098, 1099-R, 1099-S, and 1099-MISC)
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
Calendar
Year
4. Person to be contacted about this request
5. Telephone Number
200__
(
)
6. Check the boxes that apply. You need not enter the number of returns.
Magnetic
Paper
Paper
Magnetic
Paper
Combined
Magnetic
Type of
Type of
Type of
Returns
Returns
Media
Media
Media
Returns
Filer
Return
Return
Return
( )
( )
( )
( )
( )
( )
( )
W-2
1098
1099-R
W-2G
1099-S
1099-MISC
7. Has an extension of time to file federal informational returns been requested from the Internal Revenue Service?
No
Yes
Pending
(If “Yes,” attach a copy of federal Form 8809.)
If “Yes,” was the request for extension approved?
(If “Yes,” attach a copy of the extension request approval.)
No
Yes
8. State in detail why you need an extension. If you need more space, 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?
(See instructions.)
No
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 to 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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