Fillable TPG-189 Request Change of Administrator in TSC or (State of Connecticut/Department of Administrative Services)

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TPG-189 Request Change of Administrator in TSC or (State of Connecticut/Department of Administrative Services)

On average this form takes 7 minutes to complete

The TPG-189 Request Change of Administrator in TSC or (State of Connecticut/Department of Administrative Services) form is 1 page long and contains:

  • 1 signature
  • 2 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for State of Connecticut/Department of Administrative Services

BROWSE STATE OF CONNECTICUT/DEPARTMENT OF ADMINISTRATIVE SERVICES (CT) FORMS

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Department of Revenue Services
State of Connecticut
TPG-189 (Rev. 09/20)
TPG-189
Request Change of Administrator in TSC or myconneCT
Complete this form in blue or black ink only.
Purpose: Use TPG-189 to appoint a new administrator of your current Department of Revenue Services (DRS), Taxpayer Service
Center (TSC), or myconneCT account. Complete a separate TPG-189 for each TSC or myconneCT account that you need to change.
Part 1 - Business Information
In order to authenticate your identity, print all information exactly as shown on your Connecticut tax account.
Business name Connecticut Tax Registration Number
Name of current TSC or myconneCT account administrator Business telephone number
Address Number and street PO Box City or town State ZIP code
How to Submit Request
Submit your completed request using one of the following
EMAIL to: ct.ele@po.state.ct.us
FAX to: 860-297-4761
MAIL to: Department of Revenue Services
ElectronicCommerceUnit
PO Box 2937
Hartford CT 06104-2937
Authorized signature Title
Print authorized name Date
Email address Telephone number
Sign Here
Keep a copy
for your
records.
Declaration: I declare under penalty of law that I have examined this document and, to the best of my knowledge and belief, it is true, complete, and correct.
I understand that the penalty for willfully delivering false information to the DRS is subject to a ne of not more than $5,000, or 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.
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Part2-Verication
Provide information as shown on a previously led tax return (do not use information from the return you are attempting to le).
The TSC or myconneCT account administrator will not be changed if the following information is not accurately completed.
1. Enter the tax type of the return previously led. 1.
2. Enter the tax period of the return previously led.(MM/DD/YYYY) 2.
3. Enter the amount of taxliability of the return previously led. 3.
.00
CheckhereifyouwouldliketoresettheTSClogin.
CheckhereifyouwouldliketoresetmyconneCTlogin.
Part 3 - New Administrator
Name of NEW TSC or myconneCT account administrator New administrator’s telephone number
Part4-ConrmationMethod
Indicate how DRS should send your new temporary password. Select only one method below.
Mail to the same mailing address listed in Part 1 - Business Information.
Email to the following email address:
Fax to the following FAX number:
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TPG-189 Request Change of Administrator in TSC or (State of ConnecticutDepartment of Administrative Services)

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Completed 27 January 2021

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