Form Dr 21-As - Colorado Severance Tax Affiliations Schedule

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COLORADO SEVERANCE TAX
DR 21-AS (03/16/04)
COLORADO DEPARTMENT OF REVENUE
Affiliations Schedule
DENVER CO 80261-0007
Name and Address of Corporation
Federal E.I. No.
Colorado Account No.
Attach this Schedule to Form DR 20 or DR 21
(see reverse side for instructions)

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