Form Reg-8 - Application For Farmer Tax Exemption Permit
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1
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4Department of Revenue Services
For DRS Use Only
Form REG-8
Taxpayer Services Division
Connecticut Tax Registration Number
25 Sigourney St Ste 2
Hartford CT 06106-5032
Application for Farmer Tax Exemption Permit
(Rev. 07/12)
Approved
Denied
TPS #
Complete the application in blue or black ink only. Read the instructions before completing this application.
Section 1
Name of applicant (sole proprietor, partnership, corporation, or LLC)
Social Security Number (SSN) (individual)
•
•
•
•
•
•
•
•
Spouse’s first name and middle initial
Last name
(if joint application)
Spouse’s SSN
•
•
•
•
•
•
•
•
Address
Number and street
PO Box
Federal Employer ID Number (FEIN) (other)
Telephone number
(
)
City, town, or post office
State
ZIP code
Check one:
Check one:
Sole proprietor
Purchased existing
farm
Farm name
Partnership
Changed business
Corporation
structure
SMLLC
New applicant
LLC
Farm location
Number and street
Town
Renewal
LLP
Start-up farmer
Fiduciary
(See instructions.)
1. Were you engaged in agricultural production as a trade or
2. Farmland ownership: Check one.
business during the preceding taxable year? See instructions.
Own
Lease
Own part and lease part
Yes
No
4. What farm products including livestock did you produce during
the preceding taxable year? See instructions. _____________
3. Total acreage of farm: _______________________________
Total acres you used in agricultural production during the
6. Have you been issued a Sales and Use Tax Permit by the
preceding taxable year: ______________________________
Department of Revenue Services (DRS)?
Yes
No
5. What farm products including livestock will you produce during
8. If you answered Yes to 6 or 7, enter your Connecticut Tax
the next two years? See Instructions. ___________________
Registration Number. __________________________________
Do not enter Farmer Tax Exemption Permit Number or FEIN.
7. Do you have employees?
Yes
No
9. State the gross income you derived solely from agricultural production as reported
on your federal income tax return. See instructions.
In 20 ____
9a. $
00
In 20 ____
9b. $
00
Total: Add Lines 9a and 9b.
9c. $
00
Average: Divide Line 9c by 2.
9d. $
00
10. If the amount entered on Line 9b or Line 9d is less than $2,500 but you qualify because you purchased an existing agricultural business
in the current or immediately preceding taxable year, enter the following information. See instructions.
Seller’s name
Seller’s Farmer Tax Exemption Permit Number
Declaration: I declare under penalty of law that I have examined this applicaton (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, 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.
Applicant’s name (print)
Applicant’s signature
Date
Sign Here
Keep a
copy of this
Spouse’s name (print, if a joint application)
Spouse’s signature
Date
application
for your
records.
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