Department of Revenue Services
Legal Division                                              LGL-006
450 Columbus Blvd Ste 1                          Request for Issuance of a Ruling
Hartford CT 06103-1837
(Rev. 12/19)

Taxpayer’s name                                                             Social Security Number

Mailing address                                                             Connecticut Tax Registration Number

City                                     State              ZIP code        Federal Employer Identification Number

                                                                                                                  Yes No
 1.  Does this request involve a prospective (as opposed to a consummated) transaction?                              
 2.  Does this request involve an issue that is the same or similar to one: 
    A.  Being considered by the Department of Revenue Services (DRS) in connection  
       with an audit examination of this taxpayer?                                                                   
    B.  Being appealed to the Appellate Division of DRS by this taxpayer?                                            
    C.  Being litigated in the Connecticut courts by this taxpayer?                                                  
    D.  Being considered by DRS in connection with a claim for refund made by this taxpayer?                         
 3.  Is this taxpayer undergoing an audit examination by DRS with respect to any issue or tax?                       
 4.  Has this taxpayer been notified concerning a pending audit examination by DRS with respect 
    to any issue or tax?                                                                                             
 5.  Does this request involve an issue that is clearly and adequately addressed by a statute,  
    regulation, or decision of the Connecticut or federal courts or by a declaratory ruling, ruling,  
    Special Notice, Policy Statement, or tax return instruction that has been issued by DRS?                         
 6.  Has this taxpayer previously been issued a ruling on the same or a similar issue by DRS? 
    If Yes, attach a copy of the ruling.                                                                             
 7.  Has a representative been authorized to request the issuance of a ruling on behalf of this taxpayer? 
    If Yes, enter the name and address of the representative. The representative must be an individual 
    or individuals and may not sign declaration below.                                                               
     __________________________________________________________________________________
     __________________________________________________________________________________
      __________________________________________________________________________________
 8.  Enter name and address to which the original ruling and other correspondence are to be mailed.
      __________________________________________________________________________________
      __________________________________________________________________________________
      __________________________________________________________________________________

Only an individual having personal knowledge of the facts may sign the declaration below. An authorized representative may not sign the declaration. 
If this taxpayer is a corporation, partnership, trust, or estate, the individual signing the declaration on behalf of the taxpayer must be a corporate 
officer, general partner, or fiduciary, as the case may be. 
Declaration: I declare under penalty of law that I have examined this document (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.

______________________________________________________________________________________    ______________________________________
Signature                                                                                    Date
______________________________________________________________________________________    ______________________________________
Print or type name                                                                           Print or type title
The procedures that a taxpayer or authorized representative must comply with in requesting the issuance of a ruling and the procedures that 
DRS follows in issuing a ruling are described in Policy Statement 2008(2), Requests for the Issuance of a Ruling. Visit the DRS website at  
portal.ct.gov/DRS to preview and download forms and publications.