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Form CT-1120 EXT

2012

Department of Revenue Services

Application for Extension of Time to File

State of Connecticut

PO Box 2974

Corporation Business Tax Return

Hartford CT 06104-2974

Complete this form in blue or black ink only. See instructions on reverse.

(Rev. 12/12)

Enter Income Year Beginning

____________________________, 2012, and Ending

__________________________, ____________



Corporation name

CT Tax Registration Number

Taxpayer



Number and street

PO Box

DRS use only

Please

–

– 20



type

City or town

State

ZIP code

Federal Employer ID Number (FEIN)

or print.



Request for Six-Month Extension to File Form CT-1120, Form CT-1120CR, or Form CT-1120U

Each corporation must submit payment of any tax due or believed to be due with this application for an extension of time to file, whether or not

an application for federal extension has been approved. See instructions on reverse.

I request a six-month extension of time, to October 1, 2013, to file a Connecticut Corporation Business Tax Return for calendar year

2012

until ________________________ for fiscal year ending ________________________.

A federal extension has been requested on federal Form 7004, Application for Automatic Extension of Time to File Certain Business Income Tax,

Information, and Other Returns, for calendar year 2012, or for fiscal year beginning _____________________, 2012, and

ending_______________________.



Yes

If No, the reason for the Connecticut extension is ______________________________________________________________________________

_____________________________________________________________________________________________________________________



DRAFT

Are you filing Form CT-1120CR?

Yes

Are you filing Form CT-1120U?

Yes

Tentative Return

1. Tentative amount of tax due for this income year; minimum tax $250. See instructions. .................................

2. Surtax: See instructions. ..................................................................................................................................

3. Total tax: Add Line 1 and Line 2. Include tax credit recapture, if applicable. ...................................................

10/11/2012

4. Multiply Line 3 by 30% (.30) or see instructions.. .............................................

5. Multiply the number of companies included by $250. ........................................

6. Enter the greater of Line 4 or Line 5. ................................................................................................................

7. Tax credit limitation: Subtract Line 6 from Line 3. .............................................................................................

8. Tax credits: Do not exceed amount on Line 7. ..............................................................................................

9. Balance of tax payable: Subtract Line 8 from Line 3. .......................................................................................

10. Payment(s) of estimated tax .............................................................................. 10.

11. Overpayment from prior year .............................................................................

11.

12. Total payments: Add Line 10 and Line 11. ........................................................................................................

12.

13. Balance due with this return: Subtract Line 12 from Line 9. .........................................................................

13.



Mail paper return with payment to:

Mail paper return without payment to:

Department of Revenue Services

Visit the DRS Taxpayer Service Center (TSC)

State of Connecticut, PO Box 2974

State of Connecticut, PO Box 150406

at to file and pay this return

Hartford CT 06104-2974

Hartford CT 06115-0406

electronically.

Make check payable to Commissioner of

Revenue Services.

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 the Department of Revenue

Services (DRS) is a fine of not more than $5,000, 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.

Corporate officer’s name (print)

Corporate officer’s signature

Date

May DRS contact the preparer

Sign Here

shown below about this return?



Yes



Keep a

Title