Form Ct-1na - Connecticut Nonresident Income Tax Agreement printable pdf download

Department of Revenue Services

Form CT-1NA

State of Connecticut

(Rev. 12/03)

Connecticut Nonresident Income Tax Agreement

– See Instructions Below –

Nonresident’s Taxable Year

Taxable Year of S Corporation

Beginning ______________, ______, and Ending ______________, ______

Beginning______________, _______, and Ending____________, _______

NONRESIDENT SHAREHOLDER’S NAME AND MAILING ADDRESS

S CORPORATION’S NAME AND MAILING ADDRESS

NAME

STREET OR OTHER MAILING ADDRESS

CITY OR TOWN

STATE

ZIP CODE

CITY OR TOWN

STATE

ZIP CODE

SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

CONNECTICUT TAX REGISTRATION NUMBER FEDERAL EMPLOYER ID NUMBER

• •

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

• •

Internal Revenue Service Center Where Nonresident Individual’s Federal Return is Filed ____________________________________________

Who May File: A nonresident shareholder of an S corporation, whether

Purpose: File Form CT-1NA, Connecticut Nonresident Income Tax

Agreement, with the S corporation to evidence the nonresident shareholder’s

the nonresident shareholder is an individual, trust, or estate, may file this

agreement to file, if the shareholder is a nonresident individual, a timely

form to evidence the shareholder’s agreement to file a Connecticut

Form CT-1040NR/PY, Connecticut Nonresident or Part-Year Resident

income tax return and to make timely payment of the Connecticut income

Income Tax Return , for the taxable year and pay the Connecticut income

tax shown on the return. The S corporation is not required to make

tax shown to be due; or if the shareholder is a nonresident trust or estate,

composite income tax payments on behalf of a nonresident shareholder

a timely Form CT-1041, Connecticut Income Tax Return for Trusts and

who files Form CT-1NA with the S corporation.

Estates , for the trust or estate’s taxable year and pay the income tax

When and Where to File: A nonresident shareholder agreeing to

shown to be due.

file a Connecticut income tax return and to make timely payment of

An S corporation is required to make composite income tax payments

the Connecticut income tax shown on the return must complete and

on behalf of a nonresident shareholder, whether the shareholder

file Form CT-1NA with the S corporation prior to the filing of

is an individual, trust, or estate, unless one of the following conditions

Form CT-1120SI, Connecticut S Corporation Information and

Composite Income Tax Return , by the S corporation. The S corporation

is met:

shall keep and maintain the forms in its permanent records, and make

The shareholder is a nonresident individual and has elected with

them available to the Department of Revenue Services (DRS) upon request.

nine or more other shareholders who are also nonresident individuals

Form CT-1NA filed by a nonresident shareholder for a taxable year of

and who have the same taxable year and no income other

the shareholder beginning on or after January 1, 2001, will be effective

than their pro rata share of the S corporation’s income that is derived

for that taxable year and for all following taxable years, unless the

from or connected with Connecticut sources, to file Form CT-G,

shareholder revokes the agreement by providing written notice of the

Connecticut Group Income Tax Return , and to make timely

revocation to the S corporation. No such revocation shall be effective

payment of the Connecticut income tax shown on Form CT-G; or

prior to the taxable year of the shareholder, following the taxable year

during which written notice of the revocation was provided to the

The shareholder has agreed to file a Connecticut income tax return

S corporation. The S corporation must keep and maintain such written

(whether Form CT-1040NR/PY or Form CT-1041), and to make timely

notices in its permanent records, and make them available to DRS upon

payment of the Connecticut income tax shown on the return.

request.

DECLARATION: I declare that I am a nonresident of Connecticut (or, if I am acting as the fiduciary of a trust or estate, that the trust or estate is a nonresident

trust or estate, respectively) and hereby agree that I will timely file Form CT-1040NR/PY for my taxable year (or, if I am acting as the fiduciary of a nonresident

trust or estate, Form CT-1041 for the trust or estate’s taxable year) identified above and, unless I revoke this agreement by providing written notice of the

revocation to the S corporation named above, for all subsequent taxable years; make timely payment of any income tax shown to be due on such return with

respect to my pro rata share (or, if I am acting as the fiduciary of a nonresident trust or estate, the trust or estate’s pro rata share) of the income of the

S corporation named above; and agree to be subject to personal jurisdiction in Connecticut for purposes of the collection of said income tax, together with any

additions to tax, interest, and penalties.

This agreement shall be binding upon my heirs, representatives, assigns, successors, executors, and administrators.

Sign Here ________________________________________________________________________________________________________________

Your Signature

Date

Spouse’s Signature (if joint return)

Date