Form Op-383 - Rental Surcharge Annual Report - 2016
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1
2
3
4Department of Revenue Services
Form OP-383
Period ending
State of Connecticut
Rental Surcharge Annual Report
PO Box 5030
Connecticut Tax Registration Number
Hartford CT 06102-5030
(Rev. 12/16)
Federal Employer Identifi cation Number (FEIN)
General Instructions
1. This report must be postmarked on or before February 15, 2017, even if no surcharge is due
or if no rentals were made.
Due date
2. If surcharge is due, pay electronically or make check payable to Commissioner of Revenue
Services. The Department of Revenue Services (DRS) may submit your check to your bank
DRS use only
electronically.
3. Be sure to include your Connecticut Tax Registration Number on your check.
4. You must attach Schedule A to your report.
5. Complete this report in blue or black ink only.
Check here if:
This is an amended return.
You are no longer eligible to collect the surcharge.
Enter last date of liability: __________________
You have a new address, trade name, or
physical location.
Enter new mailing address: ____________________
__________________________________________
__________________________________________
Enter new trade name: ________________________
__________________________________________
Enter new physical location; not PO Box.
__________________________________________
All copies of Schedule A must be attached.
__________________________________________
00
1. Total amount received from rentals subject to 3% (.03) surcharge from Schedule A, Line 1
1.
00
2. Total amount received from rentals subject to 1.5% (.015) surcharge from Schedule A, Line 2
2.
00
3. Total surcharge actually collected from rentals from Schedule A, Line 3
3.
00
4. Personal property tax actually paid to Connecticut municipalities from Schedule A, Line 4
4.
5. Licensing, titling, and registration fees actually paid to Connecticut Department of
00
Motor Vehicles (DMV) from Schedule A, Line 5
5.
00
6. Add Line 4 and Line 5.
6.
00
7. Subtract Line 6 from Line 3. If zero or less, enter “0.”
7.
00
8. Penalty: See instructions.
8.
00
9. Interest: See instructions.
9.
10.
00
10. Total amount due: Add Lines 7, 8, and 9.
Declaration: 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 the penalty for willfully delivering a false return or document
to DRS is a fi ne of not more than $5,000, imprisonment for not more than fi ve 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.
Taxpayer’s signature
Title
Date
Taxpayer’s email address
Paid preparer’s signature
Paid preparer’s address
Date
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