DR 1317 (09/27/10)
COLORADO DEpARTmENT OF REvENUE
DENvER, COLORaDO 80261-0005
CHILD CARE CONTRIBUTION TAX
CREDIT CERTIFICATION
Organization Name
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License or DOR Registration Number
Federal Employer Identification (FEIN)
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Address
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City
State
Zip Code
Telephone Number
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Name of Preparer
Signature of Preparer
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Donor Name
Social Security Number or Colorado Account Number
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Address
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City
State
Zip Code
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Credit Computation
Date of Donation
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1. Donation amount .......................................$ ______________________
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2. Non-qualifying donation .............................$ ______________________
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3. Qualifying donation, line 1 minus line 2 .....$ ______________________
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4. Credit available, line 3 times 50% .............$ ______________________
Application of Donation
all functions of the donee organization qualify for the tax credit.
The donation is applied 100% to qualified programs of the organization.
Qualified programs that constitute _______ % of all organization programs.
Other (describe allocation below)
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Instructions
This form is to be completed by the donee organization, then given to the donor. The donee organization should
retain completed copies for record keeping.
Donors shall submit this form with their Colorado income tax return when claiming the child care contribution
credit. When filing electronically, Submit this form with form DR 1778.
Social security number may be completed by the donor after receipt from the donee organization.