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[" ( Taxpayer Name ) "," ( Taxpayer AddressLine1 ) ","  Taxpayer AddressLine2"," Taxpayer   \nCity"," Taxpayer \nState"," Taxpayer \nZip Code"," Period End Date\nFormat\nmm/dd/yyyy"," CT Tax Registration Number"," (    Household  Employer\n(Y/N)   )\n","  Total CT Tax Withheld","  Total Wages Paid","  Total Number of W-2's Submitted"," Quarter1  (withholding for 1st quarter of year)"," Quarter 2 (withholding for 2nd quarter of year)"," Quarter 3 (withholding for 3rd quarter of year)"," Quarter 4 \n(withholding for 4th quarter of year)"," Total\nMust Equal the Sum of the 4 quarters withholding","( Return Prepared by Paid Preparer? - Y/N )"," ( Paid Preparer Name ) ","  PaidPreparer FirmName","  PaidPreparer FEIN"," ( Y/N\nPaid Preparer address a foreign address ) "," PaidPreparerAddressLine1"," PaidPreparerAddressLine2"," PaidPreparerAddressLine3 \nForeign Addresses Only","PaidPreparerCity"," Paid Preparer State"," Paid Preparer Zip Code","  Paid Preparer Telephone Number"]