Form Dr 0021s - Extension Payment Voucher For Colorado Oil And Gas Severance Tax Return - 2012

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DR 0021S (10/03/12)
Web
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0007
Extension Of Time For Filing Colorado
Oil And Gas Severance Tax Return
Colorado severance tax returns are due to be filed 3½
If after the original due date of the return it is found
months after the close of the tax year.
that the amount paid is insufficient to meet the 90%
requirement, additional payment should be made as
An automatic six-month extension of time for filing the
soon as possible to reduce accumulation of penalty and
Colorado severance tax return is allowed for all taxpayers.
interest. Make such payment with the DR 0021S.
However, an extension of time to file is not an extension of
time to pay the tax. If at least 90% of the net tax liability is
Be sure to round your payment to the nearest dollar.
not paid by the original due date of the return, penalty and
The amount on the check and the amount entered on
interest will be assessed. If 90% or more of the net tax
the payment voucher must be the same. This will help
liability is paid by the original due date of the return and
maintain accuracy in your tax account.
the balance is paid when the return is filed by the last day
Submit the DR 0021S with payment to:
of the extension period, only interest will be assessed.
Colorado Department of Revenue
Use the DR 0021S to make a payment that must be made
Denver, CO 80261-0008
by the original due date of the return to meet the 90%
requirement.
Worksheet
1. Tentative amount of tax for the taxable year after reduction
for the impact assistance credit (if any) .............................................................................................$ _____________
2. Less: (a) Severance tax withheld .......................................................................................................$ _____________
(b) Estimated tax payments .....................................................................................................$ _____________
(c) Total (a) and (b) ...................................................................................................................$ _____________
3. Balance to be remitted with this request for extension, line 1 minus line 2 (c).
Enter amount of payment below. Claim credit for this payment on line 5 of the DR 0021 .................$ _____________
If no payment is due, do not file the DR 0021S.
DETACH FORM
Photocopy for your records.
ON THIS LINE
Cut here and send only the coupon below. Help us save time and your tax dollars.
(7040)
2012 Extension Payment Voucher for Colorado
DR 0021S (10/03/12)
DR 0021S (10/03/12) Web
DR 0021S (10/03/12)
Oil and Gas Severance Tax Return
16
COLORADO DEPARTMENT OF REVENUE
For tax period ________________________________________________, ending _________________________________________
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Write your Social
Security number, Colorado Account Number or Federal Employer Identification Number and DR 0021S on your check or money order. Do not send
cash. Enclose, but do not staple or attach, your payment with this voucher
.
Your Last Name
First Name and Initial
Social Security Number
Spouse’s Last Name
First Name and Initial
Spouse’s Social Security Number
Address
Federal Employer Identification Number
City
State
ZIP
IF NO PAYMENT IS DUE, DO NOT FILE THIS FORM.
Amount Owed
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.
$
. 0 0
(Do not write in space below)

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