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Dr 0253 2/12/04 - Income Tax Closing Agreement Template - Colorado Department Of Revenue

DR 0253 (02/12/04)

COLORADO DEPARTMENT OF REVENUE

DENVER CO 80261

INCOME TAX CLOSING AGREEMENT

I. TAXPAYER FOR WHICH/WHOM AGREEMENT IS SOUGHT

Name

Social Security or Colorado Account Number

Address

Taxpayer is (check one):

Individual - Give date of death _____________________ ;

Estate;

Trust;

Corporation.

II. PERSON SEEKING AGREEMENT

Name

Address

Relationship to taxpayer

Reason for seeking agreement

III. AGREEMENT:

Whereas there has been a determination of the Colorado income tax liability of said taxpayer or taxpayer's estate

for the period _______________________________________________________________________________________

in the principal sum of $ __________________________________________________________________________ and,

WHEREAS, said fiduciary, officer or agent hereby agrees to this determination and consents to the assessment and collection

of any deficiency in tax included in the amount of the principal tax liability so determined, together with any penalty or interest

applicable thereto as provided by law, and/or to accept any abatement, credit, or refund made in accordance with such

determination, together with any interest due thereon as provided by law;

NOW, THIS AGREEMENT WITNESSETH, that said fiduciary, officer or agent and said Executive Director of the Department

of Revenue of the State of Colorado hereby mutually agree that the principal amount of such liability so determined shall be final

and conclusive if and when this agreement is approved by said Executive Director of the Department of Revenue.

IN WITNESS WHEREOF, the above parties have subscribed their names to these presents.

Signed this ___________ day of ___________ , 20 ___

_____________________________________________

(Executive Director, Department of Revenue)

(Fiduciary, Officer, or Agent)

By ___________________________________________

The department of revenue hereby acknowledges receipt of $ _____________ in accordance with this agreement in full satisfaction of the

taxes for the taxable period to which the above agreement relates as provided in section 39-21-116, CRS 1973, except upon a showing of

fraud, malfeasance, or misrepresentation of a material fact.

Received By

Date

Dr 0253 2/12/04 - Income Tax Closing Agreement Template - Colorado Department Of Revenue