Form Dr 1083 - Information With Respect To A Conveyance Of A Colorado Real Property Interest 2006

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DR 1083 (07/18/06)
COLORADO DEPARTMENT OF REVENUE
DENVER CO 80261-0005
INFORMATION WITH RESPECT TO A CONVEYANCE
OF A COLORADO REAL PROPERTY INTEREST
1.
Name(s) and address of transferor(s): ______________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2.
Transferor is (check one):
individual
estate
other (specify)
corporation
trust
____________________________
_____________________________
3.
Social Security Number(s) or Colorado account number of transferor:
4.
Federal employer identification number of transferor: __________________________________________________
5.
Type of property sold: ___________________________________________________________________________
6.
Address or legal description of property sold: _________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
7.
Date of closing: _______________________________________________________________________________
8.
Selling price of the property ............................................... $ ______________________
9.
Selling price of this transferor's interest ............................. $ ______________________
10.
If Colorado tax was withheld, check this box ................................................................
11.
Amount of tax withheld ...................................................... $ ______________________
12.
If withholding is not made, give reason (check one):
a. Affirmation of Colorado residency signed ...............................................................
b. Affirmation of permanent place of business signed .................................................
c. Affirmation of principal residence signed ...............................................................
d. Affirmation of partnership signed ............................................................................
e. Affirmation of no tax reasonably estimated to be due or no gain on sale signed ....
f.
No net proceeds ........................................................................................................
13.
Name, address, and telephone number of the title insurance company or other person providing closing and settlement
services with respect to this transfer: _________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
File this form together with Form 1079, if applicable, within 30 days of the closing date with the
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005

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