Department of Revenue Services PO Box 5030 Hartford CT 06102-5030 Form OS-114 For period ending Sales and Use Tax Return (Rev. 07/11) Connecticut Tax Registration Number See Form O-88, Instructions for Form OS-114 Sales and Use Tax Return. Federal Employer Identification Number  Due date  DRS use only   Check here if this is an amended return. Rounding: You must round off cents to the nearest whole dollars on your return and schedules. If you do not round, DRS will disregard the cents. Column A 6.0% Tax Rate on or before June 30, 2011 File your return electronically using the TSC. Go to www.ct.gov/TSC. 1 Gross receipts from sales of goods 2 Gross receipts from leases and rentals 2 3 Gross receipts from labor and services 3 4 Goods purchased by your business subject to use tax Leases and rentals by your business subject to use tax Services purchased by your business subject to use tax Complete the return in blue or black ink only. Column D Column C 9.35% Tax Rate 7% Tax Rate on or after on or after July 1, 2011 July 1, 2011 Column B 6.35% Tax Rate on or after July 1, 2011 5 6 1 4 5 6 7 Total: Add Lines 1 through 6. 7 8 Deductions. See instructions. 8 9 Subtract Line 8 from Line 7. If zero or less, enter “0”. 9 10a Amount of tax due: Multiply Line 9 by Tax Rate. 10a 10b Total tax due: Add Line 10a, Columns A through D. 10b 11 For amended return only, enter tax paid on prior return. 11 12 Net amount of tax due: Subtract Line 11 from Line 10b. 12 13 Interest ________________________+ Penalty ________________________ 14 Total amount due: Add Line 12 and Line 13. = 13  14 If applicable, provide requested information below. Final return - check here  Enter last business date: ______________  First return - Enter business start date: ________________________ New owners must obtain a new Connecticut Tax Registration Number.  Enter new mailing address: _________________________________ Enter new owner information: _________________________________________________________  Name: _________________________________________________  Enter new physical location: _________________________________ (PO Box is not acceptable.)  Address: ________________________________________________ _________________________________ _________________________________________________________  Enter new trade name: ____________________________________  Date sold: _______________________________________________ Declaration: I declare under 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 DRS is a fine of not more than $5,000, imprisonment for not more than five 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. Taxpayer’s signature Title Telephone number (  ) Date   Paid preparer’s signature Paid preparer’s address Date     American LegalNet, Inc. www.FormsWorkFlow.com See Form O-88, Instructions for Form OS-114 Sales and Use Tax Return, before completing. Column A 6.0% Tax Rate Column B 6.35% Tax Rate Deductions on or before June 30, 2011 on or after July 1, 2011 15 Sales for resale - sales of goods 15 16 Sales for resale - leases and rentals Column C 7.0 % Tax Rate on or after July 1, 2011 16 17 Sales for resale - labor and services 17 18 All newspapers and subscription sales of magazines and puzzle magazines 18 19 Trucks with GVW rating over 26,000 lbs. or used exclusively for carriage of interstate freight 19 21 Food for human consumption, food sold in vending machines, items purchased with food stamps 21 23 Sale of fuel for motor vehicles 23 Utility & Heating 24 Fuel Companies Only 25 24 Sales of electricity, gas, and heating fuel for residential dwellings 25 Sales of electricity - $150 monthly charge per business 26 Sales of electricity, gas, and heating fuel for manufacturing or agricultural production 26 27 Aviation fuel 27 29 Tangible personal property to persons issued a Farmer Tax Exemption Permit 29 30 Machinery, its replacement, repair, component & enhancement parts, materials, tools, & fuel for manufacturing 30 31 Machinery, materials, tools, and equipment used in commercial printing process or publishing 31 32 Vessels, machinery, materials, tools, and fuel for commercial fishing 32 33 Out-of-state - sales of goods 33 34 Out-of-state - leases and rentals 34 35 Out-of-state - labor and services 35 36 Motor vehicles or vessels purchased by nonresidents 36 37 Prescription medicines and diabetic equipment - sales of goods 37 38 Nonprescription medicines - sales of goods 38 39 Charitable or religious organizations - sales of goods 39 40 Charitable or religious organizations - leases and rentals 40 41 Charitable or religious organizations - labor and services 41 42 Federal, Connecticut, or municipal agencies - sales of goods 42 43 Federal, Connecticut, or municipal agencies - leases and rentals 43 44 Federal, Connecticut, or municipal agencies - labor and services 44 45 Items certified for air or water pollution abatement - sales, leases, and rentals of goods 45 47 Nontaxable labor and services 47 48 Services between wholly owned business entities 48 50 Trade-ins of all like-kind tangible personal property 50 52 Taxed goods returned within 90 days at the rate listed above in Columns A, B or C 52 56 Oxygen, blood plasma, prostheses, etc. - sales, leases, rentals, or repair services of goods 56 58 Printed material for future delivery out of state 58 59 Articles of clothing or footwear under $50 59 60 Material and components for noncommercial production of clothing 60 63 Funeral expenses 63 69 Repair services, repair and replacement parts for aircraft, and certain aircraft 69 71 Certain machinery under the Manufacturing Recovery Act of 1992 71 72 Machinery, equipment, tools, supplies, and fuel used in the biotechnology industry 72 73 Repair and maintenance services and fabrication labor to vessels 73 74 Computer and data processing services at 1% (See instructions, Form 0-88.) 74 75 Renovation and repair services to residential real property 75 77 Sales of qualifying items to direct payment permit holders 77 78 Sales of college textbooks 78 79 Sales tax holiday 79 81 Residential weatherization products and compact fluorescent light bulbs 81 82 Motor vehicles sold to active duty nonresident members of the armed forces at 4.5% 82 A Other Adjustments - sales of goods (Describe:  B Other Adjustments - leases and rentals (Describe:  )B C Other Adjustments - labor and services (Describe:  )C Total Deductions: Enter here and on Line 8 on the front of this return. OS-114 Back (Rev. 07/11) )A    American LegalNet, Inc. www.FormsWorkFlow.com