Department of Revenue Services Legal Division 25 Sigourney Street Hartford CT 06106-5032 LGL-006 Request for Issuance of a Ruling (Rev. 06/08) Taxpayer’s Name Social Security Number Mailing Address Connecticut Tax Registration Number City State ZIP Code Federal Employer Identification Number Yes No 1. Does this request involve a prospective (as opposed to a consummated) transaction? 2. Does this request involve an issue that is the same or similar to one: A. Being considered by the Department of Revenue Services (DRS) in connection with an audit examination of this taxpayer? B. Being appealed to the Appellate Division of DRS by this taxpayer? C. Being litigated in the Connecticut courts by this taxpayer? D. Being considered by DRS in connection with a claim for refund made by this taxpayer? 3. Is this taxpayer undergoing an audit examination by DRS with respect to any issue or tax? 4. Has this taxpayer been notified concerning a pending audit examination by DRS with respect to any issue or tax? 5. Does this request involve an issue that is clearly and adequately addressed by a statute, regulation, or decision of the Connecticut or federal courts or by a declaratory ruling, ruling, Special Notice, Policy Statement, or tax return instruction that has been issued by DRS? 6. Has this taxpayer previously been issued a ruling on the same or a similar issue by DRS? If Yes, attach a copy of the ruling. 7. Has a representative been authorized to request the issuance of a ruling on behalf of this taxpayer? If Yes, enter the name and address of the representative. The representative must be an individual or individuals and may not sign declaration below. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 8. Enter name and address to which the original ruling and other correspondence are to be mailed. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Only an individual having personal knowledge of the facts may sign the declaration below. An authorized representative may not sign the declaration. If this taxpayer is a corporation, partnership, trust, or estate, the individual signing the declaration on behalf of the taxpayer must be a corporate officer, general partner, or fiduciary, as the case may be. Declaration: I declare under penalty of law that I have examined this 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 ______________________________________________________________________________________ Print or Type Name ______________________________________ Print or Type Title The procedures that a taxpayer or authorized representative must comply with in requesting the issuance of a ruling and the procedures that DRS follows in issuing a ruling are described in Policy Statement 2008(2), Requests for the Issuance of a Ruling. Visit the DRS website at www.ct.gov/DRS to preview and download forms and publications. American LegalNet, Inc. www.FormsWorkflow.com