Get CT DRS CT-EITC SEQ 2023-2024

Request by the DRS. Do not file Form CT EITC SEQ with your tax return. Keep a copy of the completed form for your records. If requested mail completed Form CT EITC SEQ and all documents to PO Box 2980 Hartford CT 06104-2980 Section 1 - Taxpayer Information Your first name and middle initial Last name Taxpayer Information Name of business Please type or print. Business mailing address number and street apartment number suite number PO Box Your Social Security Number Spouse s Social Security Number Employer Identification Number Home telephone number City town or post office Business telephone number If joint return spouse s first name and middle initial State ZIP code Business website if any Cell telephone number Section 2 - Business Information Federal Schedule K-1s Schedule C etc. Provide a description of your business type of work products sold services provided and hours of operation Date business began / / Date business began in Connecticut / / Have you received any Forms 1099-MISC or 1099 NEC for income you earned in 2021 If your occupation requires you to have a license attach a copy of that license. Department of Revenue Services State of Connecticut Rev. 12/21 Form CT-EITC SEQ Earned Income Tax Credit Self-Employed Questionnaire Complete in blue or black ink only. Enter all applicable information in Sections 1 2 and 3 and attach copies of all required documents. Indicate if you use any of the following methods to advertise your business. Attach copies of advertisements along with any paid receipts. No Yes If Yes attach a copy of each 1099-MISC or 1099 NEC. Newspaper Internet/website Flyers Other Under Connecticut Law you must keep adequate business records. See Informational Publication 2015 20 Connecticut Earned Income Tax Credit Recordkeeping Requirements for Self-employed Persons. Indicate which of the following types of records you keep to verify your business income and expenses. Accounting records Computer records Insurance Business bank account s Ledgers Rental expenses Car/truck expenses Log books Suppliers name and address Paid invoices/receipts Other Attach copies of these records covering at least two months of the tax year in question* Section 3 - Declaration and Signature Declaration I declare under penalty of law that I have examined the information contained on this questionnaire 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 the Department of Revenue Services 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. Sign Here Your signature Date Spouse s signature Keep a Paid preparer s signature copy for your Firm s name address and ZIP code records. Indicate if you use any of the following methods to advertise your business. Attach copies of advertisements along with any paid receipts. No Yes If Yes attach a copy of each 1099-MISC or 1099 NEC. Newspaper Internet/website Flyers Other Under Connecticut Law you must keep adequate business records.