Form 104x - Amended Colorado Individual Income Tax Return

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(15)
FORM 104X (Rev. '99)
AMENDED COLORADO INDIVIDUAL
INCOME TAX RETURN
FOR TAX PERIOD
LAST NAME
FIRST NAME AND MIDDLE INITIAL
SOCIAL SECURITY NUMBER
Yourself
Your Spouse
Address
Your Telephone Number
(
)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
City, State and ZIP Code
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1
Reason for amended
Investment credit carryback from tax year ending ____________________________
return (check one):
Federal net operating loss carryback from tax year ending _____________________
Protective claim, explain on reverse side
Other, explain on reverse side
NET CHANGE
CORRECT
ORIGINAL AMOUNT
Round all amounts to the nearest dollar
INCREASE OR (DECREASE)
AMOUNT
OR AS PREVIOUSLY ADJUSTED
.00
1. Federal taxable income .......................................... 1
.00
.00
.00
2. Colorado additions to federal income .................... 2
.00
.00
.00
3. Total of lines 1 and 2 .............................................. 3
.00
.00
.00
4. Colorado subtractions from federal income ............ 4
.00
.00
5. Colorado taxable income, line 3 minus line 4 ......... 5
.00
.00
.00
.00
6. Colorado Tax .......................................................... 6
(06
)
.00
.00
.00
7. Alternative minimum tax ......................................... 7
(17
)
.00
.00
.00
8. Recapture taxes ..................................................... 8
(34
)
.00
.00
.00
9. Total lines 6,7, and 8 .............................................. 9
.00
.00
10. Form 104CR - Part III, personal credits ................ 10
.00
(37
)
.00
.00
.00
.00
11. From 104CR - Part III, alternative fuel credits ...... 11
(67
)
.00
.00
12. Form 104CR - Part IV, enterprise zone credits .... 12
(29
)
.00
.00
.00
.00
13. Total lines 10, 11 and 12 ...................................... 13
.00
.00
.00
14. Net tax, line 9 minus line 13 ................................. 14
.00
15. State sales tax refund ........................................... 15
.00
(24
)
.00
.00
.00
16. Colorado income tax withheld .............................. 16
(07
)
.00
.00
.00
17. Estimated tax and extension payments and credits17
(03
)
.00
.00
.00
18. Child care/child tax credit ..................................... 18
(65
)
.00
.00
.00
19. Earned income credit ........................................... 19
(68
)
.00
.00
20. Amount of tax paid with original return plus additional tax paid after it was filed ................................................... 20
.00
21. Total of lines 15, 16, 17, 18, 19 and 20 .................................................................................................................. 21
.00
22. Overpayment of tax on original return or as previously adjusted (refund, contributions, credit to estimate) ... 22
.00
23. Net credit available, line 21 minus line 22 ....................................................................................................... 23
.00
24. Additional tax due, line 14 minus line 23 ......................................................................................................... 24
.00
25. Interest due on additional tax - see instructions .............................................................................................. 25
(11)
.00
26. Penalty due - see instructions ......................................................................................................................... 26
(01)
.00
27. Estimated tax penalty due - see instructions ................................................................................................... 27
(76)
.00
28. Payment due with this return, add lines 24, 25, 26 and 27 ............................................................................. 28
(08)
.00
29. Refund claimed with this return, line 23 minus line 14 .................................................................................... 29
.00
30. Interest allowed on refund. To be computed by Department of Revenue ...................................................... 30
(11X)
.00
31. Penalty reduced .............................................................................................................................................. 31
(01X)
.00
32. Estimated tax penalty reduced ........................................................................................................................ 32
(76X)
.00
33. Total refund due. To be computed by Department of Revenue ...................................................................... 33
(04)
.00
34. Overpayment credited to estimated tax ........................................................................................................... 34
(14 )
.00
(Name and Telephone Number of Individual
(Date)
SIGNED UNDER PENALTY OF PERJURY IN THE SECOND DEGREE:
(Signature of Taxpayer)
(Date)
or Firm Preparing Return)
(Signature of Taxpayer's Spouse, if joint return)
(Date)

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