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Department of Revenue Services
State of Connecticut Form CT-590
(Rev. 04/23) Athlete or Entertainer Request for Waiver of Withholding
Complete this return in blue or black ink only. Mail to: DRS, Audit Division, 450 Columbus Blvd Ste 1, Hartford CT
An athlete, entertainer, performing artist, including a member of an 06103-1837.
athletic team, or performing entity uses this form to request a waiver of The completed form may be emailed to DRSAthletesEnt@ct.gov or
Connecticut income tax withholding from a designated withholding agent. faxed to 959-200-4831.
After completing, signing, and dating this form, the performer or performing If the request is granted, DRS will send Form CT-595, Notice to
entity submits it to the designated withholding agent. Designated Withholding Agent, to the designated withholding agent
If Part Iof this form is completed, signed, and dated by the performer(s) and a copy to the performer(s) or performing entity. If a designated
or performing entity and taken in good faith, the designated withholding withholding agent has not received Form CT-595 on or before the
agent is not required to withhold Connecticut income tax from the payment date that payment is made to the performer or performing entity, the
being made to the performer(s) or performing entity. The designated designated withholding agent should either (a) presume the request has
withholding agent must keep this form for at least four years after the been denied and withhold Connecticut income tax at a rate of 6.99%
date of the performance. of the gross payment to the performer or performing entity, or (b) the
If Part IIof this form is completed, signed, and dated by the performer(s) designated withholding agent or the performer or performing entity
or performing entity, the designated withholding agent must mail or fax may call theDRS Audit Division at860-297-5925 for information on
this form to the Department of Revenue Services (DRS) and must withhold the status of the request.
Connecticut income tax unless DRS grants the request. The designated withholding agent may be instructed by DRS to return
This form must be received by DRS at least 14 calendar days before the any excess amounts withheld to the performer or performing entity.
date of the first payment or the date of the first performance, whichever For more information, see Policy Statement 2018(1), Income Tax
is earlier. Withholding for Athletes or Entertainers, or call 860-297-5925.
Performer(s) or Performing Entity
Name of performer(s) or performing entity Social Security Number or Federal Employer Identification Number
Address (number and street), apartment number, PO Box
City, town, or post office State ZIP code
Designated Withholding Agent
Name of designated withholding agent Connecticut Tax Registration Number
Address (number and street), apartment number, PO Box
City, town, or post office State ZIP code
Name of venue Date(s) of performance Amount to be paid to performer(s) or performing entity
Part I – Designated Withholding Agent Keeps Form - Do Not Send to DRS
Declaration by Resident Performer
I am a resident of Connecticut and reside at the address shown above. I have filed all required Connecticut tax returns, past and present, and have paid all
required Connecticut taxes, including any required estimated Connecticut income tax for the current taxable year. Should I cease to be a Connecticut resident,
I will promptly inform you. I understand that, even if Connecticut income tax is not withheld from the payment made to me for my performance in Connecticut
at the above-named venue on the above-specified date(s) of performance, the payment remains subject to Connecticut income tax. I declare under penalty of
law that the information contained on this form is, to the best of my knowledge and belief, true, complete, and correct. I understand that the penalty for willfully
delivering a false return, statement, or other document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Signature Date
Declaration by Performer who is an Employee of Designated Withholding Agent
I am treated, for federal income tax withholding purposes, as an employee of the designated withholding agent. Should I cease to be treated, for federal income
tax withholding purposes, as an employee of the designated withholding agent, I will promptly inform you. I declare under penalty of law that the information
contained on this form is, to the best of my knowledge and belief, true, complete, and correct. I understand that the penalty for willfully delivering a false return,
statement, or other document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Signature Date
Declaration by Performing Entity Continuously Maintaining an Office in Connecticut
The performing entity named above has an office in Connecticut at the address shown above, and the office is continuously maintained, occupied, and used by
the performing entity’s regular employees who are regularly in attendance to carry on its business in its own name. The performing entity has filed all required
Connecticut tax returns, past and present, and has paid all required Connecticut taxes. Should the performing entity cease to have an office in Connecticut,
I will promptly inform you. I understand that, even if Connecticut income tax is not withheld from the payment made for the performing entity’s performance in
Connecticut at the above-named venue on the above-specified date(s) of performance, the payment remains subject to Connecticut income tax. I declare under
penalty of law that the information contained on this form is, to the best of my knowledge and belief, true, complete, and correct. I understand that the penalty for
willfully delivering a false return, statement, or other document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Name and title (type or print)
Signature Date
Visit us at portal.ct.gov/DRS for more information.
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