Form Reg 1 – Fill Out and Use

Department of Revenue Services

DRS use only - Connecticut Tax Registration Number

State of Connecticut

Form REG-1

PO Box 2937

Hartford CT 06104-2937

Business Taxes Registration Application

(Rev. 09/19)

Sole proprietorship

Single member LLC (SMLLC)

 C corporation

General partnership

Single member LLC taxed as a C corporation

 S corporation

Single member LLC taxed as an S corporation

 Qualified subchapter S subsidiary (QSSS)

Limited partnership (LP)

Limited liability company (LLC) taxed as a C corporation

Limited liability company (LLC) taxed as an S corporation

Limited partnership taxed as a C corporation

 Other (explain): __________________________________________________________________

Retailer

Wholesaler

Manufacturer

Service provider

Other (explain): _______________________________________

Entity name: Enter the name of the sole proprietor, partnership, corporation, or LLC.

Federal Employer Identification Number (FEIN), if applicable

Trade or “doing business as” name

CT Secretary of the State Business ID No., if applicable

Business Location: Enter the physical address of the business. A post office box or rural route number is not acceptable. Home-based businesses and

flea market or craft show vendors must enter a home address.

Physical address (PO Box not accepted)

number and street

City

State

ZIP code

Mailing address (if different from physical address)

number and street or PO Box

City

State

ZIP code

Business telephone number

Email address

Business bank name

–

–

City

State

ZIP code

Home telephone number

–

–

SSN/FEIN

Date of birth

Bank name

__ __

/ __ __

/ __ __ __ __

m m

d d

y y y y

Name (last, first, middle initial)

Title

SSN/FEIN

Date of birth

Bank name

__ __

/ __ __

/ __ __ __ __

m m

d d

y y y y

7. Income Tax Withholding

Are you an employer that transacts business or maintains an office in Connecticut and intends

 Yes  No

to pay wages to resident employees or nonresident employees who work in Connecticut?

Are you an out-of-state company voluntarily registering to withhold Connecticut

 Yes

 No

income tax for your Connecticut resident employees who work outside of Connecticut?

Do you transact business or maintain an office in Connecticut and intend to make payments.............................................of pensions,

 Yes

 No

annuities, retirement distributions, or gambling winnings to Connecticut residents?

Do you pay nonresident athletes or entertainers for services they render in Connecticut?

 Yes

 No

Do you only have household employees and wish to withhold Connecticut income tax? (see instructions)

 Yes

 No

Do you only have agricultural employees and wish to withhold Connecticut income tax?

 Yes

 No

If YES, do you file federal Form 943, Employer’s Annual Tax Return for Agricultural Employees,

 Yes

 No

and wish to file Form CT-941, Connecticut Quarterly Reconciliation of Withholding, annually?

If you answered YES to any of the income tax withholding questions,

__ __ / __ __ / __ __ __ __

enter the date you will start withholding Connecticut income tax

m m

d d

y

y y y

Form REG-1 (Rev. 09/19)

Page 2 of 4

Do you sell, or will you be selling, goods in Connecticut (either wholesale or retail)?

 Yes

 No

Do you rent equipment or other tangible personal property to individuals or businesses in Connecticut?

............

 Yes

 No

Do you serve meals or beverages in Connecticut?

 Yes

 No

Do you provide a taxable service in Connecticut? For a list of taxable services, visit the DRS website at

 Yes

 No

portal.ct.gov/DRS to review Informational Publication 2018(5), Getting Started in Business

Are all of your sales made through a marketplace facilitator that collects and remits sales tax for you?

.............

 Yes

 No

If you answered YES to any of the sales and use taxes questions,

__ __ / __ __ / __ __ __ __

enter the date you will start selling or leasing goods or taxable services

m

m

d

d

y

y

y

y

9. Prepaid Wireless E 9-1-1 Fee

 Yes

 No

Do you sell prepaid wireless services in Connecticut?

If you answered YES, enter the date you will start to sell these in Connecticut

__ __ / __ __ / __ __ __ __

m

m

d

d

y

y

y

y

Do you provide or facilitate the provision of rooms for rent in a furnished home, hotel, motel, lodging house, or

 Yes

 No

bed and breakfast establishment in Connecticut for 30 consecutive days or less?

If you answered YES, enter the date you will start to provide or facilitate the provision of rooms

__ __ / __ __ / __ __ __ __

for rent for lodging purposes in Connecticut

m

m

d

d

y

y

y

y

11. Corporation Business Tax or Unrelated Business Income Tax

Corporation Business Tax

Are you a C corporation?

 Yes

 No

Are you an LLC, SMLLC, or other entity taxed as a C corporation?

 Yes

 No

Is this corporation exempt from federal income tax?

 Yes

 No

Have you received a determination from the Internal Revenue Services (IRS) that this

 Yes

 No

corporation is exempt from federal income tax?

If YES, enclose a copy of your IRS letter of determination.

__ __ / __ __ / __ __ __ __

Enter state you are organized under: _______________________________ Enter date of organization . ...

m

m

d

d

y

y

y

y

If not a Connecticut corporation, enter the earlier of the date you started business in

__ __ / __ __ / __ __ __ __

Connecticut or the date you registered with the Connecticut Secretary of the State

Enter the month the corporate year closes: ________________________

m

m

d

d

y

y

y

y

Passive Investment Company (PIC)

Is this corporation a passive investment company as defined in Conn. Gen. Stat. § 12-213(a)(27)?

...................

 Yes

 No

Enter the date the PIC was organized

__ __ / __ __ / __ __ __ __

m

m

d

d

y

y

y

y

Are you a federally exempt organization that has unrelated................................................................................................business income

 Yes

 No

attributable to a trade or business in Connecticut?

If you answered YES, enter the date the unrelated business income tax liability started

__ __ / __ __ / __ __ __ __

m m d d

y

y y y

Will you be purchasing or renting................................................................................................................................taxable goods or services for use in Connecticut without

 Yes

 No

paying Connecticut sales tax?

If you answered YES to the business use tax question, enter the tax liability start date

__ __ / __ __ / __ __ __ __

If you answered NO, you must complete the following BUSINESS USE TAX DECLARATION.

m m

d d

y

y y y

Form REG-1 (Rev. 09/19)

Page 3 of 4

a. If registering for sales and use taxes or room occupancy tax, enter $100.*

a.

c. Total registration fee due: Add Line a and Line b

c.

Sign here

Signature of owner, partner, LLC member, or corporate officer

Date

Telephone number

and keep

–

–

a copy for

your

Print name of owner, partner, LLC member, or corporate officer

Title

records.

Form REG-1 (Rev. 09/19)

Page 4 of 4