Form Dr 0100 - Colorado Retail Sales Tax Return Page 3
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4Departmental Use Only
DR 0100 (06/18/14)
COLORADO DEPARTMENT OF REVENUE
Colorado Retail
Denver, CO 80261-0013
Sales Tax Return
Signed under penalty of perjury in the second degree.
Signature
Date
(MM/DD/YY)
*140100V219999*
SSN 1
SSN 2
FEIN
Last Name or Business Name
First Name
Middle Initial
Address
City
State
Zip
0021-101
Phone
(1-4)
1. Gross Sales and Services for this site/location only
(
)
00
(include bad debts previously deducted)
Colorado Account Number
(2a-4)
Period
2. Deductions (nontaxed sales):
(MM/YY-MM/YY)
–
00
a. Sales to other licensed dealers, for resale
Due Date
Location/Juris Code
(2b-4)
(MM/DD/YY)
00
b. Other deductions (from page 2)
Mark here if this is an
00
c. Total (add lines 2a & 2b)
Amended Return
County/MTS
City/LID
Special District
State
(3-1)
(3-2)
(3-3)
(3-4)
00
00
00
00
3. Net sales: (line 1 minus line 2c)
(3a-1)
(3a-2)
(3a-3)
(3a-4)
00
00
00
00
a. Sales out of taxing area
(3b-1)
(3b-2)
(3b-3)
(3b-4)
00
00
00
00
b. Exemptions (list on page 2).
(3c-1)
(3c-2)
(3c-3)
(3c-4)
c. Overpayment from previous
00
00
00
00
return
4. Net taxable sales
00
00
00
00
(line 3 minus a,b,& c)
Tax Rate
00
00
00
00
5. Amount of sales tax
(6-1)
(6-2)
(6-3)
(6-4)
00
00
00
00
6. Excess tax collected
00
00
00
00
7. Total (add lines 5 & 6)
8. a. Service fee rate
(8-1)
(8-2)
(8-3)
(8-4)
b. Service fee allowed vendor
00
00
00
00
(only if paid on or before due date)
9. Sales tax due
00
00
00
00
(line 7 minus line 8b)
(10-1)
(10-2)
(10-3)
(10-4)
10. Tax on $
00
00
00
00
(11-1)
(11-2)
(11-3)
(11-4)
00
00
00
00
11. Total tax due (add lines 9 & 10)
(12-1)
(12-2)
(12-3)
(12-4)
00
00
00
00
12. Penalty:
(13-1)
(13-2)
(13-3)
(13-4)
13. Monthly interest rate times
00
00
00
00
line 11 .0025
14. Total each tax
00
00
00
00
(add lines 11, 12, & 13)
The State may convert your check to a one time electronic banking transaction. Your
bank account may be debited as early as the same day received by the State. If
15. Total Amount Owed
converted, your check will not be returned. If your check is rejected due to insufficient
Paid by EFT
(add all columns
or uncollected funds, the Department of Revenue may collect the payment amount
$
. 0 0
(355)
on line 14)
directly from your bank account electronically.
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