Form Dr 5774 - Eft Authorization Individual Income Tax Page 3

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2002
Estimated Income Tax
70
(12)
COLORADO
Payment Voucher
104-EP
(Calendar year - Due June 17, 2002)
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 "2002 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 or account number
AMOUNT OF
Spouse's last name
First name and initial
Spouse's social security number or account number
PAYMENT
Address
(08)
.00
City
State
ZIP
DO NOT WRITE BELOW THIS LINE

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