Form 104x - Amended Colorado Individual Income Tax Return

Department Use Only

FORM 104X (12/30/11)

104X

2011 FORM

COLORADO DEPARTMENT OF REVENUE

DENVER CO 80261-0005

(0015)

AMENDED COLORADO INDIVIDUAL INCOME TAX RETURN

Reason for amended return (check one):

Investment credit carryback from tax year ending _______________________________

Federal net operating loss carryback from tax year ending _________________________

Federal net capital loss carryback from tax year ending __________________________

Protective claim, attach explanation

Other, attach explanation

Changing filing status

Changing residency status

LAST NAME

FIRST NAME AND INITIAL

DECEASED

SOCIAL SECURITY NUMBER

Yourself

YES

Spouse, if joint

YES

Mailing Address

Your telephone number

(

)

City

State

ZIP Code

Email Address

AS AMENDED

1. ENTER FEDERAL TAXABLE INCOME from your federal income tax return: 1040EZ line 6;

1040A line 27; 1040 line 43 .......................................................................................................................

ADDITIONS

2. STATE ADDBACK enter the state income tax deduction from your federal 1040

schedule A (see instructions) ....................................................................................................................

3. OTHER ADDITIONS, explain (see instructions) ........................................................................................

4. Subtotal, add lines 1 through 3 .................................................................................................................... 4

SUBTRACTIONS

5. STATE INCOME TAX REFUND enter the state income tax refund from line 10 of your federal 1040 ......

6. US GOVERNMENT INTEREST ................................................................................................................

7. PRIMARY TAXPAYER PENSION/ANNUITY income (Beneficiaries, list deceased’s SSN: ____________)

8. SPOUSE PENSION/ANNUITY income, if any (Beneficiaries, list deceased’s SSN: ____________) ......

9. COLORADO SOURCE CAPITAL GAIN 5-year assets acquired on or after 5/9/1994 ..............................

10. TUITION PROGRAM CONTRIBUTION:

Total Contribution $_______________________

Owner’s Name _____________________

Owner’s SSN ___________________ (see instructions) . 10

11. QUALIFYING CHARITABLE CONTRIBUTION

Total Contributions $ ___________________ ............... 11

12. OTHER SUBTRACTIONS, check appropriate box:

PERA contribution made in 1984–1986;

DPSRS contributions made in 1986;

tier I or II railroad benefits;

qualified reservation income

wildfire mitigation measures. ................................................................................................................. 12

13. Subtotal, add lines 5 through 12 .................................................................................................................. 13

14. COLORADO TAXABLE INCOME, line 4 minus line 13 ............................................................................. 14

CALCULATE YOUR TAX: FULL-YEAR RESIDENTS TURN TO PAGE 22 PART-YEAR RESIDENTS AND NONRESIDENTS GO TO 104PN

TAX, PREPAYMENTS AND CREDITS

15. COLORADO TAX from tax table or 104PN line 36 ............................................................... 15

16. ALTERNATIVE MINIMUM TAX from Form 104AMT ............................................................ 16

17. RECAPTURE of prior year credits........................................................................................ 17

18. Subtotal, add lines 15 through 17 ............................................................................................18

19. NON-REFUNDABLE CREDITS from 104CR line 49, cannot exceed the sum of lines 15 + 16 . 19

20. NET TAX, subtract line 19 from line 18....................................................................................20

21. COLORADO INCOME TAX WITHHELD from W-2 and 1099 statements ............................ 21

22. ESTIMATED TAX enter the sum of payments and credits and amounts withheld from

nonresident real estate sales and partnership/S corp/fiduciary income ............................... 22

23. REFUNDABLE CREDITS from 104CR line 9....................................................................... 23

24. Subtotal, add lines 21 through 23 ............................................................................................24

25. FEDERAL ADJUSTED GROSS INCOME from your federal income tax return:

1040EZ line 4; 1040A line 21; 1040 line 37 .......................................................................... 25

If you want the Department of Revenue to compute and mail your refund, or compute your balance due and mail a bill, stop here

and leave lines 26 through 41 blank. If you want to compute the refund or balance due yourself, continue with line 26.

AMENDED

Form 104x - Amended Colorado Individual Income Tax Return - 2011

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