Form 104 Ep - Individual Income Tax Page 5
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52003
Estimated Income Tax
70
(12)
COLORADO
Payment Voucher
104-EP
(Calendar year - Due January 15, 2004)
FORM
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Please write your social security
number and "2003 Form 104-EP" on your check or money order. Please do not send cash. Enclose, but do not staple or attach, your payment with this voucher.
File only if you are making a payment of estimated tax.
Your last name
First name and initial
Your social security number
Spouse's last name
First name and initial
Spouse's social security number
Address
City
State
ZIP
Do not write in space below.
(08)
AMOUNT OF PAYMENT
00
104 EP 02
10
10/8/02, 2:32 PM
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