Form Ct-592 - Athlete Or Entertainer Withholding Tax Statement - Department Of Revenue Services Of State Of Connecticut

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State of Connecticut
20
Department of Revenue Services
(Rev. 07/05)
Form CT-592
Athlete or Entertainer Withholding Tax Statement
Performing Entity: Complete and provide this form to each member or participant. Keep a copy for your
records.
Member or Participant: Attach this form to your completed Form CT-1040, Form CT-1040EZ, or Form
CT-1040NR/PY
.
Part 1 Member or Participant Information
Part 2 Designated Withholding Agent Information
Name, Address (number and street), City, State, ZIP Code
Name, Address (number and street), City, State, ZIP Code
Social Security Number or Federal Employer Identification Number
Connecticut Tax Registration Number
Part 3 Performing Entity Information
Name, Address (number and street), City, State, ZIP Code, and Telephone Number
Connecticut Tax Registration Number, Federal Employer Identification Number, or Social Security Number
Part 4 Date(s) for Which Payment Is Rendered
Part 5 Tax Withheld
Date(s) of Performance
1. Amount Subject to Withholding
1. $
2. Total Connecticut Tax Withheld
2. $

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Parent category: Financial
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