Form Dr 0011 - Passenger Mile Detail By Passenger Buses Page 3
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3DR 0011 (12/94)
COLORADO DEPARTMENT OF REVENUE
PASSENGER MILE DETAIL BY PASSENGER BUSES
Use this form to calculate your "Passenger Mile Tax" to be entered on line 1 of your Passenger Mile and Special
Fuel User Tax Return (DR 0133). You must retain this passenger mile detail in your own records and make it avail-
able to the Colorado Department of Revenue upon request.
Instructions-For Each Trip Provide:
1)
The Date of the Trip
2)
The Vehicle I.D. or Unit Number
3)
The Point of Departure
4)
The Final Destination (treat each stopping point at which you load or unload passengers as a "Final Destination," even
though you might be continuing on with the same vehicle.)
5)
Miles Traveled in Colorado
6)
The Number of Passengers
For each trip, multiply the Colorado miles in column 5 times the number of passengers in column 6 to determine the taxable
passenger miles. Enter this figure in column 7. Photocopy this form if additional lines are needed.
Add all the numbers in column 7 to determine the total passenger miles for the reporting period. Enter this number on line 8
at the bottom of this form.
Name
Account Number
Period
(3)
(4)
(5)
(6)
(7)
(1)
(2)
Date
Vehicle I.D. Number
From
To
Miles Traveled in
No. of
Passenger Miles
Colorado
Passengers
(5) X (6)
Total Passenger Miles
8) _______________ X $.001 = _____________
Enter this figure on Line 1 of DR 0133
(Total Passenger Miles)
(Passenger Mile Tax)
PAGE 3 OF 3
EXCISE 14 (04/05)
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