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State of Connecticut

Form CT-8109 (DRS)

2006

Department of Revenue Services

Connecticut Withholding Tax Payment Form for Nonpayroll Amounts

(Rev 12/05)

Purpose: Form CT-8109 (DRS), Connecticut Withholding Tax

Each calendar year DRS classifies payers for Connecticut income

Payment Form for Nonpayroll Amounts, is an interim coupon to

tax withholding purposes either as a weekly, monthly , or quarterly

be used by new payers or payers who have not received the 2006

remitter. Most new payers will be classified as monthly remitters.

Withholding Remittance Coupon Book for Payers of Nonpayroll

The filing frequency is based on the payer’s reported liability

Amounts. Once the withholding book is received, use only the

for the tax required to be deducted and withheld during the

preprinted coupons in the book.

look-back calendar year. The look-back calendar year for

calendar year 2006 is calendar year 2004. See Special Notice

2004(10), 2004 Legislation Affecting Connecticut Income Tax

Withholding by Payers From Nonpayroll Amounts Paid on or After

January 1, 2005, and the schedule on the back of this return.

PAYER’S RECORD OF PAYMENT

Weekly Remitters Only: Enter date nonpayroll amount was paid.

All payers of nonpayroll amounts that are subject to Connecticut

_ _ /_ _ / 200 6

income tax withholding are required to withhold Connecticut

income tax at the time payments of nonpayroll amounts are made.

1. Enter Quarter (1, 2, 3, or 4)

Use Form CT-8109 (DRS), to make your payments to Department

(See Instructions.)

of Revenue Services (DRS). (See back of return for nonpayroll

2. Connecticut Tax Withheld

amounts subject to withholding.)

Do not file Form CT-8109 (DRS) if no payment is due.

Instructions for Completing Form CT-8109 (DRS)

Monthly or Quarterly remitters: Enter the total amount of

Connecticut income tax withheld from nonpayroll amounts for

In the appropriate box, enter name, address, and identification

the month or quarter. Pay the total amount shown on Line 2.

numbers. For weekly remitters only, enter the date the

Make your check payable to: Comissioner of Revenue Services.

nonpayroll amount was paid, not the due date of the coupon.

DRS may submit your check to your bank electronically. Write

Line 1: Enter the number of the quarter during which this

your Connecticut Tax Registration Number and the calendar

payment was made to payees. Enter 1 for the 1st quarter

quarter during which the payment was made to payees on your

(January 1 through March 31); 2 for the 2nd quarter (April 1 through

check or use the Fast-File Program to file and make your

June 30); 3 for the 3rd quarter (July 1 through September 30); or

payment. Visit and click on File/Register

4 for the 4th quarter (October 1 through December 31).

OnLine. Mail the completed coupon and payment to: DRS,

Note: If the tax liability was incurred during one quarter and

PO Box 2931, Hartford CT 06104-2931.

paid to DRS in another quarter, enter the number for the quarter

in which the tax liability was incurred. For example, if the tax

Electronic Filing Option:

liability was incurred in March and paid to DRS in April, enter 1

File by internet: Connecticut Fast-File

on Form CT-8109 (DRS), Line 1.

Visit the DRS Web site at

Line 2:

and click on

Weekly remitters: Enter the total amount of Connecticut

File/Register OnLine or call the DRS

income tax withheld from nonpayroll amounts paid on the date

Forms Unit at 860-297-4753 and request

entered above Form CT-8109 (DRS), Line 1.

TPG-129, Fast-File in Five.

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

2006

CT-8109 (DRS)

Connecticut Withholding Tax Payment Form for Nonpayroll Amounts

Connecticut Tax Registration Number

Federal Employer ID Number

Year

2006

Weekly Remitters Only: Enter date nonpayroll amount was paid.

Enter name and address below. Please print or type.

_ _ /_ _ / 200 6

1. Enter Quarter (1, 2, 3, or 4)

(See Instructions.)

2. Connecticut Tax Withheld

Do not file this Form CT-8109 (DRS) if no payment is due.

Pay total amount shown on Line 2.

If filing by mail, send payment to:

DRS, PO Box 2931, Hartford CT 06104-2931

Make check payable to: Commissioner of Revenue Services.

Write your Connecticut Tax Registration Number on your check.

DO NOT FOLD OR BEND COUPON

Electronic Filing: Connecticut Fast-File ( )

Form Ct-8109 (Drs) - Connecticut Withholding Tax Payment Form For Nonpayroll Amounts

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