Form Dr-0461 - Monthly Return Of Oil And Gas Tax Withheld printable pdf download

DR 0461 (08/28/07)

Departmental Use Only

COLORADO DEPARTMENT OF REVENUE

MONTHLY RETURN OF OIL

DENVER CO 80261-0007

AND GAS TAX WITHHELD

Name

COLORADO ACCOUNT NUMBER

Address

FEDERAL EMPLOYER I.D. NUMBER

City

State

ZIP

PERIOD COVERED

DUE DATE

Make checks or money orders payable to:

month

year

month

day

year

COLORADO DEPARTMENT OF REVENUE

INSTRUCTIONS

Oil and gas withholding must be remitted electronically. This form may be used only until your EFT account is

established. Penalty and interest will apply to payments submitted with this form if you are not actively pursuing an

EFT account.

LINE 1:

Enter the total of all Colorado oil and gas severance taxes withheld from disbursements made during the month.

LINE 2:

Enter the total of any under payment adjustments for prior periods. Explain on reverse side.

LINE 3:

Enter the total of any overpayment (not to exceed the sum of Lines 1 and 2) adjustments for prior tax periods.

Explain on reverse side.

LINE 4:

Penalty: 30% of tax or $30.00, whichever is greater if return is delinquent.

LINE 5:

Interest applies at the current rate on the total tax due from the date due until paid if the return is delinquent.

LINE 6:

Enter the total. (Add lines 1, 2, 4 and 5 minus Line 3.)

OIL and GAS

(4000-100)

.00

1. Total Colorado Severance Tax Withheld ________________________________________________

(100)

.00

2. Additional Tax Due for Prior Period ____________________________________________________

(900)

.00

3. Overpayment of Tax for Prior Period to be applied to Current Tax ____________________________

(905)

.00

4. Penalty __________________________________________________________________________

(200)

.00

5. Interest __________________________________________________________________________

(300)

.00

6. Total Amount Due and Payable _______________________________________________________

(355)

PLEASE INCLUDE THE ACCOUNT NUMBER ON YOUR CHECK TO ENSURE PROPER CREDIT

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 bank account electronically.

I hereby certify under penalty of perjury in the second degree that this return, including any accompanying schedules and statements, is a true, correct

and complete return to the best of my knowledge.

Trade Name

Date

Telephone

Signature of Officer or Agent

Title