Form Dr 0022 - Colorado Severance Tax Return Molybdenum Ore
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1
2Departmental Use Only
DR 0022 (08/21/06)
COLORADO DEPARTMENT OF REVENUE
DENVER CO 80261-0007
(53)
COLORADO SEVERANCE TAX RETURN
MOLYBDENUM ORE
Taxable Quarter
Year
Due Date
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
20______
Name
Colorado Account Number
Address
Federal Employer I.D. Number
City
State
ZIP Code
Telephone Number
(
)
–
Please provide a telephone number, including area code, where you can be reached during business hours. This number will be kept confidential.
1. TAX - Molybdenum Ore, enter amount from back, line 7 ................................................................ (32)
2. Impact Assistance Credit ................................................................................................................ (43)
3. Line 1 less Line 2, enter balance of tax due ...................................................................................
4. Interest on balance due .................................................................................................................. (40)
5. Penalty on balance due .................................................................................................................. (01)
$
.00
6. Total Amount Due, add lines 3, 4 and 5.
(48)
Make checks payable to: Colorado Department of Revenue ..
The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same
day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds,
the Department of Revenue may collect the payment amount directly from your banking account electronically.
Under penalty of perjury in the second degree, I declare that I have examined this return
Name, address and telephone number of person
and to the best of my knowledge and belief it is true, correct, and complete.
preparing return:
Signature of Taxpayer or Corporate Officer
Date
Signature of Spouse
Date
MAKE CHECKS PAYABLE TO:
Colorado Department of Revenue,
Denver, CO 80261-0007
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