Form Ct-1041 Ext - Application For Extension Of Time To File Connecticut Income Tax Return For Trusts And Estates - 2005

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Department of Revenue Services

2005

Form CT-1041 EXT

State of Connecticut

(Rev. 12/05)

Application for Extension of Time to File

Connecticut Income Tax Return for Trusts and Estates

Important! Please read instructions on reverse before completing this application.

Name of Trust or Estate

Federal Employer Identification Number

•

Name and Title of Fiduciary

DRS Use Only

Taxpayer

–

– 20

(Please Type

Address of Fiduciary

Number and Street

PO Box

Decedent’s Social Security Number (For Estates Only)

• •

or Print)

• •

City, Town, or Post Office

State

ZIP Code

This is not an extension of time to pay your tax. You must include payment of any tax due or penalty and interest may apply (see

instructions). However, if you expect to owe no additional Connecticut income tax for the 2005 taxable year, after taking into account any

Connecticut income tax withheld or estimated Connecticut income tax payments you made, or both, and you requested an extension

of time to file your 2005 federal income tax return, you are not required to file Form CT-1041 EXT.

I request a six-month extension of time to October 15, 2006, to file my Connecticut Income Tax Return for Trusts and Estates for

calendar year 2005, or until ________________________ , _____ , for fiscal year ending

________________________ , _____ .

I have requested a federal extension on federal Form 7004, Application for 6-Month Extension of Time to File Certain Business Income

Tax, Information, and Other Returns, for calendar year 2005 or fiscal year beginning _______________________________ , _____

and ending ____________________________________ , ____________ .

Yes

If No, the reason for the Connecticut extension is _________________________________________________________________

_________________________________________________________________________________________________________

_______________________________________________________________________________________________

You will be notified only if your extension request is denied.

1. Total Connecticut income tax liability for 2005 (You may estimate this amount.)

An amount must be entered on Line 1. If you do not expect to owe income tax, enter

“0.” ................

2. Connecticut income tax withheld .............................................................................................................. 2

3. 2005 estimated Connecticut income tax payments including any 2004

overpayments credited to 2005 ................................................................................................................. 3

4. Add Line 2 and Line 3. ............................................................................................................................... 4

5. Connecticut income tax balance due (Subtract Line 4 from Line 1.) Pay in full with this form.

If Line 4 is greater than Line 1, enter

“0.” ......................................................................................................

Make check or money order payable to: Commissioner of Revenue Services. The Department of Revenue Services (DRS)

may submit your check to your bank electronically.

Write the Federal Employer Identification Number (FEIN) of the trust or estate and “2005 Form CT-1041 EXT” on the check or

money order.

Mail to:

Department of Revenue Services

PO Box 2934

Hartford CT 06104-2934

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 fine of not more than $5,000, or 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.

Signature of Fiduciary or Officer Representing Fiduciary

Date

Telephone Number

(

)

Sign Here

Paid Preparer’s Signature

Date

Preparer’s PTIN or SSN

Keep a copy

of this

Firm’s Name and Address