Department of Revenue Services
OP-337
For Period Ending
State of Connecticut
PO Box 2997
Tourism Surcharge Return
Connecticut Tax Registration Number
Hartford CT 06104-2997
on the Rental/Leasing
(Rev. 08/05)
of Passenger Motor Vehicles
Federal Employer Identification Number
Due Date
For DRS Use Only
If the address
at right is
incorrect,
Check here if this is an amended return.
please make
any changes
If you have ceased leasing operations,
necessary
enter date you ceased operations:
New address or trade name:
Enter new mailing address:
Enter new trade name:
Enter new physical location (Not PO box):
1.
Number of passenger motor vehicles subject to surcharge
1
2.
Total number of days the vehicles from Line 1 were rented or leased
2
3.
Amount of surcharge due (Multiply Line 2 by $1.)
3
00
4.
Credit for uncollectible accounts (See Instructions.)
4
00
5.
Net surcharge due (Subtract Line 4 from Line 3.)
5
00
6.
Penalty (See Instructions.)
6
00
7.
Interest (See Instructions.)
7
00
8.
Total amount due (Add Lines 5, 6, and 7.)
8
00
General Instructions
You must complete this return in blue or black ink only.
Due Date: The due date of the return is the last day of the month
after the end of the period indicated above.
Make your check payable to: Commissioner of Revenue
New Owners: Do not use the previous owner’s form to file your
Services. Include your Connecticut tax registration number on
return. Any change in ownership requires a new Connecticut tax
your check. The Department of Revenue Services (DRS) may
registration number.
submit your check to your bank electronically.
Signature: You must sign the return.
You must file a return even if no surcharge is due. Enter “0” on
Line 1 and Line 2 and sign the return.
If you have questions, call Taxpayer Services at 1-800-382-9463
(within Connecticut) or 860-297-5962 (from anywhere). Preview
Rounding: You must round off cents to the nearest whole dollar
and download forms and publications from the DRS Web site at
on your returns and schedules.
See Line Instructions on back.
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 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.
Taxpayer’s Signature
Title
Date
Preparer’s Signature
Preparer’s Address
Date