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Connecticut Free Printable  for 2020 Connecticut Substitute for Forms W-2 and 1099-R

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Substitute for Forms W-2 and 1099-R
Form CT-4852

Department of Revenue Services State of Connecticut 450 Columbus Blvd Hartford CT 06103-1837 (Rev. 12/18) Form CT-4852 Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, Etc. Purpose Complete Form CT-4852, if you have been unable to obtain (or have received an incorrect) Form W-2, Wage and Tax Statement, or Form 1099R (Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.) from an employer or payer and have notified the Internal Revenue Service. A separate Form CT-4852 must be completed for each missing or incorrect Form W-2 or Form 1099R. General Information First name and middle initial Last name Mailing address Number and street Apt. No. City, town, or post office State ZIP Code Social Security Number __ __ __ •• • __ __ Telephone number •• • __ __ __ __ ( ) Substitute Form Information 1. Please fill in the year at the end of this statement. I have been unable to obtain (or have received an incorrect) Form W-2 or Form 1099R from my employer or payer named below. The amounts shown below are my best estimates of all wages or payments paid to me and the federal and Connecticut taxes withheld by this employer or payer during _____________ (year). 2. Name, address, city, state, and ZIP code of employer or payer 3. Connecticut Tax Registration # of employer or payer (if known) 4. Federal Employer Identification # of employer or payer (if known) 5. Federal income tax withheld 6. Wages, tips, other compensation or payments (See below.) 7. Connecticut income tax withheld 8. Connecticut wages, tips, etc. Include total wages paid, noncash payments, tips reported, and all other compensation before deductions for taxes, insurance, etc. in Box 6 and Box 8. 9. How did you determine the amounts in Boxes 5 through 8 above? If you received a Form W-2 showing federal wages and federal income tax withheld, attach a copy to Form CT-4852. If you did not receive a Form W-2 but you file federal Form 4852 to report federal wages and federal tax withheld, attach a copy of federal Form 4852 to Form CT-4852. Do not attach Form CT-4852 to your Connecticut income tax return. Keep Form CT-4852 with your tax records. You may be asked by the Department of Revenue Services (DRS) to provide a copy of Form CT-4852 at a later date. _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ 10. Give reason Form W-2, 1099R, or W-2C, Corrected Wage and Tax Statement, was not furnished by the employer or payer, if known, and explain your efforts to get it. _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Declaration: I declare under penalty of law that I have examined this return or 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 _________________________________________
Extracted from PDF file 2019-connecticut-form-ct-4852.pdf, last modified October 2018

More about the Connecticut Form CT-4852 Individual Income Tax TY 2019

We last updated the Substitute for Forms W-2 and 1099-R in March 2020, so this is the latest version of Form CT-4852, fully updated for tax year 2019. You can download or print current or past-year PDFs of Form CT-4852 directly from TaxFormFinder. You can print other Connecticut tax forms here.

Other Connecticut Individual Income Tax Forms:

TaxFormFinder has an additional 85 Connecticut income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Tax Instruction Booklet Form CT-1040 Instruction Booklet
CT-1040NR/PY Instructions Tax Instruction Booklet: CT-1040 for Nonresidents/Part-Year Residents
Form CT-1040 Connecticut Resident Income Tax Return
Form CT-1040NR-PY Nonresident/Part-Year Resident Tax Return
CT-1040ES (Current Year) Estimated Connecticut Income Tax Payment Coupon for Individuals

Download all CT tax forms View all 86 Connecticut Income Tax Forms


Form Sources:

Connecticut usually releases forms for the current tax year between January and April. We last updated Connecticut Form CT-4852 from the Department of Revenue Services in March 2020.

Show Sources >

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Connecticut Form CT-4852

We have a total of nine past-year versions of Form CT-4852 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing Plans, IRAs, Insurance Contracts, Etc. 2015 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing Plans, IRAs, Insurance Contracts, Etc. 2014 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing Plans, IRAs, Insurance Contracts, Etc. 2013 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing Plans, IRAs, Insurance Contracts, Etc. 2012 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P

Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing Plans, IRAs, Insurance Contracts, Etc. 2011 Form CT-4852

Form CT-4852, Substitute for Form W-2, Wage and Tax Statement, or Form 1099R, Distributions From Pensions, Annuities, Retirement or Profit-Shariing P


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