Form REG-1 Addendum E "Miscellaneous Taxes" - Connecticut

What Is Form REG-1 Addendum E?

This is a legal form that was released by the Connecticut Department of Revenue Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Connecticut Department of Revenue Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form REG-1 Addendum E by clicking the link below or browse more documents and templates provided by the Connecticut Department of Revenue Services.

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Download Form REG-1 Addendum E "Miscellaneous Taxes" - Connecticut

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REG-1 Addendum E
Department of Revenue Services
State of Connecticut
Miscellaneous Taxes
(Rev. 06/18)
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for any of the
taxes listed below. Register on the Taxpayer Service Center (TSC) at www.ct.gov/TSC for taxes listed on Form REG-1.
File this addendum in person at any regional office or mail it to: Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. There is no fee to register for any of the taxes listed below.
Check the tax(es) you are applying for and enter the start date. See instructions on Page 2 for detailed descriptions of taxes.
Enter Start Date
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Ambulatory Surgical Center Provider ............................................................
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Enter Connecticut Department of Public Health Ambulatory Surgical Center license number:
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Hospital Provider .............................................................................................
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m m
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y y y y
Enter Connecticut Department of Public Health Hospital license number: .............................
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Intermediate Care Facility Provider ................................................................
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m m
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y y y y
Enter Connecticut Department of Developmental Services license number: .........................
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Nursing Home Provider ..................................................................................
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m m
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y y y y
Enter Connecticut Department of Social Services license number: ....................................
Bottle Deposit Initiator ....................................................................................
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m m
d d
y y y y
Railroad Companies ........................................................................................
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m m
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y y y y
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Solid Waste Assessment ................................................................................
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m m
d d
y y y y
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Transportation Network Company ..................................................................
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m m
d d
y y y y
Certified Competitive Video Service Provider ..............................................
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__ __
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m m
d d
y y y y
Community Antenna Television Company .....................................................
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m m
d d
y y y y
Satellite Company ............................................................................................
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y y y y
Cable, Satellite, and Video Provider * .............................................................
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* This is a surtax imposed on any person registered as a Certified Competitive Video
m m
d d
y y y y
Service Provider, Community Antenna Television Company, or Satellite Company.
Utility Companies
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Electric Distribution Company .......................................................................
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m m
d d
y y y y
Participating Municipal Electric Utility ..........................................................
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y y y y
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Gas Company ..................................................................................................
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y y y y
Suppliers of Natural Gas .................................................................................
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y y y y
REG-1 Addendum E
Department of Revenue Services
State of Connecticut
Miscellaneous Taxes
(Rev. 06/18)
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for any of the
taxes listed below. Register on the Taxpayer Service Center (TSC) at www.ct.gov/TSC for taxes listed on Form REG-1.
File this addendum in person at any regional office or mail it to: Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. There is no fee to register for any of the taxes listed below.
Check the tax(es) you are applying for and enter the start date. See instructions on Page 2 for detailed descriptions of taxes.
Enter Start Date
/
/
Ambulatory Surgical Center Provider ............................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Enter Connecticut Department of Public Health Ambulatory Surgical Center license number:
/
/
Hospital Provider .............................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Enter Connecticut Department of Public Health Hospital license number: .............................
/
/
Intermediate Care Facility Provider ................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Enter Connecticut Department of Developmental Services license number: .........................
/
/
Nursing Home Provider ..................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Enter Connecticut Department of Social Services license number: ....................................
Bottle Deposit Initiator ....................................................................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
Railroad Companies ........................................................................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
/
/
Solid Waste Assessment ................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
/
/
Transportation Network Company ..................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Certified Competitive Video Service Provider ..............................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
Community Antenna Television Company .....................................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
Satellite Company ............................................................................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
Cable, Satellite, and Video Provider * .............................................................
/
/
__ __
__ __
__ __ __ __
* This is a surtax imposed on any person registered as a Certified Competitive Video
m m
d d
y y y y
Service Provider, Community Antenna Television Company, or Satellite Company.
Utility Companies
/
/
Electric Distribution Company .......................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Participating Municipal Electric Utility ..........................................................
/
/
__ __
__ __
__ __ __ __
m m
d d
y y y y
/
/
Gas Company ..................................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Suppliers of Natural Gas .................................................................................
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/
__ __
__ __
__ __ __ __
m m
d d
y y y y
REG-1 Addendum E Instructions
Ambulatory Surgical Center
Any entity included in the federal definition of an ambulatory surgical center set forth in 42 C.F.R. 416.2 that is licensed as an outpatient
surgical facility by the Connecticut Department of Public Health and any other ambulatory surgical center that is Medicare certified.
Enter license number issued by Connecticut Department of Public Health.
Hospital Provider
Any health care facility, as defined in section 19a-630 of the Connecticut general statutes, that is licensed by the Department of Public
Health as a short-term general hospital; is maintained primarily for the care and treatment of patients with disorders other than mental
diseases; meets the requirements for participation in Medicare as a hospital; and has in effect a utilization review plan, applicable to all
Medicaid patients, that meets the requirements of 42 CFR 482.30.
Enter license number issued by Connecticut Department of Public Health.
Intermediate Care Facility Provider
A residential facility for persons with intellectual disability that is certified to meet the requirements of 42 CFR 442,
Subpart C, and in the case of a private facility, licensed pursuant to section 17a-227 of the Connecticut general statutes.
Enter license number issued by Connecticut Department of Developmental Services.
Nursing Home Provider
Any licensed chronic and convalescent nursing home or rest home with nursing supervision.
Enter license number issued by Connecticut Department of Social Services.
Bottle Deposit Initiator
The first distributor to collect the deposit on a beverage container sold to any person within Connecticut.
Railroad Companies
Any person owning, leasing, maintaining, operating, managing, or controlling any railroad, or any cars or other equipment employed on
or connected with a railroad, for public or general use.
Solid Waste Assessment
Imposed on owners of any resource recovery facility for all solid waste processed at the facility.
Transportation Network Company
Any entity operating in Connecticut using a digital network to connect network riders to network drivers to provide prearranged rides. This
does not include the holder of a certificate of public convenience and necessity to operate a taxicab or the holder of a permit to operate a
motor vehicle livery service.
Certified Competitive Video Service Provider
Any person providing video service under a certificate of video franchise authority issued by the Connecticut Department of Energy and
Environmental Protection, Public Utilities Regulatory Authority (PURA) authorizing the entity to provide video service in Connecticut.
Community Antenna Television Company
Any person owning, leasing, maintaining, operating, managing, or controlling a community antenna television system for the purpose of
providing the service for hire and includes any municipality which owns or operates one or more plants for the manufacture or distribution of
electricity and seeks to obtain or obtains a certificate of public necessity to construct or operate a community antenna television system.
Satellite Company
Any person that transmits video programming by satellite to Connecticut.
Cable, Satellite, and Video Provider
This is a surtax imposed on any person registered as a Certified Competitive Video Service Provider, Community Antenna Television
Company, or Satellite Company.
Utility Companies
Electric Distribution Company
Any person providing electric distribution services within Connecticut.
Participating Municipal Electric Utility
A municipal electric utility or any other electric utility owned, leased, maintained, operated, managed, or controlled by any unit of local
government to provide electric generation services to end use customers outside its service area.
Gas Company
Any person owning, leasing, maintaining, operating, managing, or controlling mains, pipes, or other fixtures, in public highways or
streets, for the transmission or distribution of gas for sale for heat or power within Connecticut or engaged in the manufacture of gas to
be transmitted or distributed.
Suppliers of Natural Gas
Any person that sells natural gas to an end user in Connecticut.
REG-1 Addendum E (Rev. 06/18)
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