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
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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.
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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 ( )