Form Dr 1091 - Backup Withholding Tax Return - Gaming

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DR
1091 (03/01/06)
COLORADO DEPARTMENT OF REVENUE
INSTRUCTIONS FOR COMPLETING
TAXPAYER SERVICES
BACKUP WITHHOLDING TAX RETURN - GAMING
1375 SHERMAN
DENVER, COLORADO 80261
(Includes slot machines, bingo, and horse and dog racing)
Please return the completed and signed lower portion of the return. Be sure the entire from is complete. return must be filed
monthly even when no tax is due.
Line 1:
Enter the total state tax withheld on line 14 of all Federal forms W-2G.
Line 2:
Enter the total state income tax withheld from non-resident aliens on line 12 of Federal form 1042S.
Line 3:
Enter the total of lines 1 and 2.
Lines 4&5:
Failure to file the return and pay the tax on time subjects the vendor to a penalty of 5% + 1/2% per month with the maximum
being 12% or a minimum of $5.00. Interest is due at the current statutory rate.
Line 6:
Enter the total of lines 3, 4, and 5.
Line 7:
If an under payment of tax was made on a previous return, enter the amount of underpayment plus penalty and interest line 7.
Line 8:
If an overpayment of tax was made on a previous return, enter the amount of the overpayment on line 8. Overpayment must not
result in a negative balance.
Line 9:
Enter the total amount due (line 6 plus line 7 or minus line 8).
HOW TO FILE A RETURN: this return, together with remittance by check, draft, or money order made payable to the Colorado Department of
Revenue, must be filed with the Colorado Department of Revenue, 1375 Sherman Street, Denver, CO 80261, on or before the 15th day of the
month following the close of the taxable period. Mailed returns must be postmarked the 15th day of the month or prior thereto.
HOW TO REMIT W-2G FORMS: The Colorado copies of the W-2G forms must be sent to the attention of fair share Section, Colorado Dept. of
revenue, 1375 Sherman #634, Denver Colorado 80261. Forms can be remitted as often as monthly but have to be remitted annually at a
minimum. DO NOT SENT W-2G FORMS WITH THIS RETURN.
Any questions regarding the preparation of this return may e directed to (303) 238-SERV (7378).
▼ DETACH HERE & MAIL WITH REMITTANCE ▼
DR 1091 (03/01/06)
BACKUP WITHHOLDING TAX RETURN - GAMING
7
1010-100
COLORADO DEPARTMENT OF REVENUE
Resident income tax withheld
ACCOUNT NUMBER
PERIOD
DUE DATE
1
line 14 W-2G
Non-resident/alien income
2
tax withheld line 12 1042S
Social Security Number 1
Social Security Number 2
F.E.I.N.
3
Total of lines 1 and 2
(100)
4
Penalty
(200)
SIGNED UNDER PENALTY OF PERJURY IN THE SECOND DEGREE
5
Interest
(300)
6
Total of lines 3, 4 and 5
Signature
Date
Phone
Additional tax, penalty, &
7
interest due for prior
(900)
periods
Overpayment of tax for
prior tax periods to be
8
subtracted from
(905)
current tax
If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment
TOTAL DUE (line 6 plus
9
(355)
amount directly from your banking account electronically
line 7 or minus line 8

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