
Rounding: You must round o cents to
the nearest whole dollar on your return
and schedules.
Column 1 Column 2 Column 3 Column 4
General Sales Meals and Beverages
(Eective 10/1/19. See instructions.)
Luxury Rental of Passenger
Motor Vehicles
6.35% Tax Rate 7.75% Tax Rate
7.35% Tax Rate 9.35% Tax Rate
1.
Gross receipts from
sales of goods ......................................
1.
.00 .00 .00
2.
Gross receipts from
leases and rentals................................
2.
.00 .00 .00
3.
Gross receipts from
labor and services ...............................
3.
.00
4.
Goods purchased by your business
subject to use tax ................................
4.
.00 .00 .00
5.
Leases and rentals by your business
subject to use tax ................................
5.
.00 .00 .00
6.
Services purchased by your business
subject to use tax ................................
6.
.00
7.
Total: Add Lines 1 through 6. ..........
7.
.00 .00 .00 .00
8.
Deductions. See instructions. .............
8.
.00 .00 .00 .00
9.
Subtract Line 8 from Line 7.
If zero or less, enter “0”. ......................
9.
.00 .00 .00 .00
10a.
Amount of tax due:
Multiply Line 9 by Tax Rate. ................
10a.
.00 .00 .00 .00
10.
Total tax due: Add Line 10a, Columns 1, 2, 3, and 4. .............................................................................................
10.
.00
11a.
Plastic Bag Fee: Total Number of Plastic Bags × $ 0.10 =
11a.
.00
11.
For amended return only, enter tax paid on prior return. .............................................................................................
11.
.00
12.
Net amount due: Subtract Line 11 from the sum of Line 10 and Line 11a. ................................................................
12.
.00
13.
Interest + Penalty =
13.
.00
14.
Total amount due: Add Line 12 and Line 13. ...............................................................................................................
14.
.00
Form OS-114
Connecticut Sales and Use Tax Return
Department of Revenue Services
PO Box 5030
Hartford CT 06102-5030
(Rev. 09/20)
OS114 0819W 01 9999
See Form O-88, Instructions for Form OS-114 Connecticut Sales and Use Tax Return. Type or print. Complete the return in blue or black ink only. Do not use grayed-out elds. Do not use staples.
For period ending Due date
Connecticut Tax Registration Number
(MMDDYYYY)
(MMDDYYYY)
Taxpayer Name
Federal Employer Identication Number
Address (number and street), apartment number, PO Box
Check here if:
Change of address:
Enter last business date:
(MMDDYYYY)
City, town, or post oce State ZIP code Amended return:
Final return:
This return MUST be filed electronically!
DO NOT MAIL paper tax return to DRS.
Sign Here
Keep a
copy of
this return
for your
records.
Taxpayer’s signature Title Date Telephone number
Taxpayer’s email
Paid preparer’s signature Paid preparer’s address Date
This return MUST be filed electronically!
DO NOT MAIL paper tax return to DRS.
Declaration:
I declare under the penalty of law that I have examined this return (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 the Department of Revenue Services (DRS) is a
ne of not more than $5,000, imprisonment for not more than ve years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of
which the preparer has any knowledge.
M M - D D - Y Y Y Y
M M - D D - Y Y Y Y