Form 104-Ep - Estimated Income Tax Payment Voucher - 2004 Page 4

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DR 104EP (08/25/04) Web
COLORADO DEPARTMENT OF REVENUE
DENVER, CO 80261-0008
Estimated Income Tax Payment Voucher
SEE FORM AT BOTTOM OF PAGE
DETACH FORM
ON THIS LINE
70
(12)
Estimated Income Tax
2005 COLORADO
FORM 104-EP
Payment Voucher
(Calendar year - Due September 15, 2005)
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Write your social security
number and "2005 Form 104-EP" on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher.
File only if you are making a payment of estimated tax. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect
the payment amount from your banking account electronically.
Your last name
First name and initial
Your social security number
Spouse's last name
First name and initial
Spouse's social security number
Address
City
State
ZIP
$
Do not write in space below.
(08)
AMOUNT OF PAYMENT
00

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