CT-3911 Form PDF Details

Taxpayers in Connecticut may find themselves in situations where their state tax refund goes missing or is reported stolen. To navigate through such an unfortunate scenario, the State of Connecticut Department of Revenue Services provides a crucial resource: Form CT-3911. This form is specifically designed for individuals or businesses to report issues regarding a Connecticut tax refund that was either supposed to be directly deposited into a bank account or issued as a physical check. It's important to note that this form is not applicable for issues related to debit card refunds—for such cases, contacting CHASE CUSTOMER SERVICE directly is advised. Form CT-3911 demands careful completion, requiring the use of blue or black ink only and necessitates the attachment of any correspondence previously received from the Department of Revenue Services (DRS) about the refund. Upon submission, if, after six weeks, there's no correspondence from DRS, it's essential to follow up directly. The Department of Revenue Services takes these matters seriously, providing written updates about the refund process, including issuing a replacement check if it's determined the original was never cashed. The form meticulously guides the taxpayer through providing refund information, including checking with one’s bank first, before moving on to detailed taxpayer information and finally, requiring a declaration signature that validates the information provided. Submission details are clearly outlined, offering both mailing and faxing options, ensuring the taxpayer knows exactly where and how to file this important document.

QuestionAnswer
Form NameCT-3911 Form
Form Length1 pages
Fillable?Yes
Fillable fields31
Avg. time to fill out6 min 31 sec
Other namesct 3911 form, ct taxpayer statement form, form ct 3911, 3911 statement tax form

Form Preview Example

Other ___________________________________
Business
Individual

Department of Revenue Services State of Connecticut

Form CT-3911

(Rev. 07/16)

Taxpayer Statement Regarding State of Connecticut Tax Refund

 

Use Form CT-3911 to report a missing or stolen Connecticut tax refund that was a direct deposit or issued as a check.

Do not use this form to report a missing debit card. Contact CHASE CUSTOMER SERVICE at 866-586-1705 to report lost, stolen, not received, or damaged debit cards and to request a new card(s).

General Instructions

Complete this form in blue or black ink only.

Attach copies of any correspondence received from DRS concerning this refund to Form CT-3911.

If you do not receive any information from DRS within six weeks after filing Form CT-3911, contact DRS at 800-382-9463 (Connecticut calls outside the Greater Hartford calling area only) or 860-297-5962 (from anywhere).

The Department of Revenue Services (DRS) will provide information in writing concerning your refund. If DRS determines that your refund check was cashed, a copy of the cashed check will be mailed to you. If DRS determines that your refund check was not cashed, a stop payment will be placed on the original check and a replacement check will be mailed to you.

Where to File

Mail to: Department of Revenue Services Revenue Accounting Unit

PO Box 5035

Hartford CT 06102-5035

Fax to: 860-297-5703

Part I Refund Information

Prior to completing Part I, verify with your bank that the refund has not been deposited.

1. Type of return filed:

Form:____________________ Tax period: _________________ Date filed: _____________________________

2.Type of refund requested: Direct Deposit Check

If Direct Deposit, enter your bank information:

Bank name: __________________________________________ Account #:

____________________________

If Check, identify if the refund check was:

Never received; or

Lost, stolen or destroyed.

Part II Taxpayer Information

Print your name, Taxpayer Identification Number (TIN), and mailing address. For individuals, the TIN is your Social Security Number (SSN); for businesses, the TIN is your Connecticut Tax Registration Number or Federal Employer Identification Number (FEIN). Check the box to indicate which TIN you are listing. If you filed a joint return, you must complete Lines 1, 2, and 3.

1. Your name (or business name)

Enter your TIN and check the appropriate box.

SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CT Reg. No.

 

 

 

 

 

 

 

 

FEIN

 

 

 

 

 

 

 

 

2. Spouse’s name (if joint return)

Spouse’s SSN

 

 

 

 

 

 

 

 

 

•

 

•

 

 

 

 

 

 

•

 

•

 

 

 

 

___ ___ ___

•

___ ___

•

___ ___ ___ ___

 

 

•

•

 

 

 

 

 

 

 

 

 

 

3. Address (number and street)

Apt. no.

PO Box

City

State

ZIP Code

Home/cell telephone number

()

Part III

Signature

Sign below exactly as you signed the original return. For a joint return, both you and your spouse must sign. For business returns, the signature must be of the person authorized to sign the check.

Declaration: I declare under penalty of law that I have examined this document 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 fi ve years, or both.

Please

sign

here.

Your signature

Title (if business return)

Date

 

 

 

Spouse’s signature (if joint return)

 

Date

 

 

 

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Find out how to prepare ct 3911 tax portion 1

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ct 3911 tax writing process described (step 2)

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