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Get CT DRS CT-1096 2011

City State ZIP code Do not send payment with this return. Mail to: Department of Revenue Services State of Connecticut PO Box 5081 Hartford CT 06102-5081 1. 00 2. 00 3. Number of 1099-MISC, 1099-R, or W-2Gs submitted Address 1. Connecticut income tax withheld from Connecticut nonpayroll amounts 2. Total nonpayroll amounts reported with Form CT-1096 Name 3. I declare under penalty of law that I have examined this return (including any accompanying schedules and statem.

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