- Paper: Letter (8.5in x 11in)
- Copies to print: 2
- Do not mail this form to the Department of Revenue Services.
- Give the certificate to your employer.
- Employees filing this form must also submit form CT-W4.
Employees must complete this form if the following are true:
- Nonresident who performs services partly within and partly outside of Connecticut for the same employer.
- The percentage of services you perform within Connecticut has changed from the percentage you indicated on the most recent CT-W4NA on file with your employer.
- Residency status has changed from resident to nonresident.
- To be used by nonresidents to file exemption from state withholding tax.
- Connecticut Dept. of Revenue Services
- CT State Tax Information: (860) 297-5962
- CT State Tax Information: (800) 382-9463 (Within CT)