Form Ct-590 - Athlete And Entertainer Request For Walver Of Withholding - Department Of Revenue Services Of State Of Connecticut
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1
2STATE OF CONNECTICUT
FORM CT-590
FORM CT-590
FORM CT-590
FORM CT-590
FORM CT-590
DEPARTMENT OF REVENUE SERVICES
RESET FORM
(Rev. 01/2002)
Athlete or Entertainer Request for Waiver of Withholding
II
PURPOSE: A performer or performing entity uses this form to request
If Part
of this form is completed, signed, and dated by the
a waiver of Connecticut income tax withholding from a designated
performer or performing entity, the designated withholding
withholding agent. After completing, signing, and dating this form,
agent must send the request for waiver to DRS and must
withhold Connecticut income tax unless DRS grants the
the performer or performing entity submits it to the designated
withholding agent.
request.
I
If Part
of this form is completed, signed, and dated by the
This form should be sent or faxed to: DRS, Audit Division,
performer(s) or performing entity, the designated withholding agent
Entertainment Withholding Section, 25 Sigourney Street, Hartford
need not send the request for waiver to the Department of Revenue
CT 06106-5032 (Fax: 860-541-4599). If the request is granted,
Services (DRS) and is not required to withhold Connecticut income
DRS will send a Form CT-595 to the designated withholding agent
and a copy to the performer(s) or performing entity. For more
tax from the payment being made to the performer or performing
entity as long as the form is taken in good faith by the designated
information, see Policy Statement 2002(1), Income Tax Withholding
for Athletes or Entertainers , or call the Entertainment Withholding
withholding agent. The designated withholding agent must retain
this form for no less than four years after the date of the performance.
Section at: 860-541-4550.
PERFORMER(S) OR PERFORMING ENTITY
Name of Performer(s) or Performing Entity
Address
City, State, ZIP Code
Social Security Number or Federal Employer Identification Number
DESIGNATED WITHHOLDING AGENT
Name of Designated Withholding Agent
Address
City, State, ZIP Code
Connecticut Tax Registration Number
Name of Venue
Date(s) of Performance
PART I . – WHERE FORM CT-590 NEED NOT BE SUBMITTED TO DRS BUT MUST BE RETAINED BY
THE DESIGNATED WITHHOLDING AGENT
DECLARATION BY RESIDENT PERFORMER
I am a resident of Connecticut and reside at the address shown above. I have filed all required Connecticut tax returns, past and present,
and have paid all required Connecticut taxes, including any required estimated Connecticut income tax for the current taxable year. Should
I cease to be a Connecticut resident, I will promptly inform you. I understand that, even if Connecticut income tax is not withheld from the
payment made to me for my performance in Connecticut at the above-named venue on the above-specified date(s) of performance, the
payment remains subject to Connecticut income tax. I declare under penalty of law that the information contained on this form is, to the
best of my knowledge and belief, true, complete, and correct. I understand that the penalty for willfully delivering a false statement to DRS
is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Signature
Date
DECLARATION BY PERFORMER WHO IS AN EMPLOYEE OF DESIGNATED WITHHOLDING AGENT
I am treated, for federal income tax withholding purposes, as an employee of the designated withholding agent. Should I cease to be
treated, for federal income tax withholding purposes, as an employee of the designated withholding agent, I will promptly inform you. I
declare under penalty of law that the information contained on this form is, to the best of my knowledge and belief, true, complete, and
correct. I understand that the penalty for willfully delivering a false statement to DRS is a fine of not more than $5,000, or imprisonment
for not more than five years, or both.
Signature
Date
DECLARATION BY PERFORMING ENTITY CONTINUOUSLY MAINTAINING AN OFFICE IN CONNECTICUT
The performing entity named above has an office in Connecticut at the address shown above, and the office is continuously maintained,
occupied, and used by the performing entity’s regular employees who are regularly in attendance to carry on its business in its own
name. The performing entity has filed all required Connecticut tax returns, past and present, and has paid all required Connecticut taxes.
Should the performing entity cease to have an office in Connecticut, I will promptly inform you. I understand that, even if Connecticut
income tax is not withheld from the payment made for the performing entity’s performance in Connecticut at the above-named venue on
the above-specified date(s) of performance, the payment remains subject to Connecticut income tax. I declare under penalty of law that
the information contained on this form is, to the best of my knowledge and belief, true, complete, and correct. I understand that the penalty
for willfully delivering a false statement to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Name and Title (type or print)
Signature
Date
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