Form Dr 1101 - Annual Reconciliation Of Income Tax Withheld On Gaming Winnings - Colorado Department Of Revenue
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1DR 1101 (09/30/09)
AnnuAl ReconciliAtion of income tAx
Withheld on GAminG WinninGs
instRuctions
Use this form to reconcile the amount of backup withholding remitted with the total
reported on Forms W-2G.
If additional tax is due, put the amount on Line 3A. Compute penalty at the larger
of 5% (.05) of the balance due for the first month you are late and 1/2% (.005)
additional penalty for each additional month you are late. The maximum penalty is
12% (.12), and the minimum penalty is $5.
Compute the interest due at the statutory rate printed on the form.
If there is an overpayment, put the amount of Line 3B. You must apply for a refund
of the overpayment of tax by filing Form DR 0137. This form may be obtained online
at
Do not send Forms W-2G with this form. Mail them to:
Colorado Department of Revenue
Attn: Fair Share Section
1375 Sherman St., Rm. 634
Denver CO 80261-0009
detAch beloW
COLORADO DEPARTMENT OF REVENUE- ANNUAL RECONCiLiATiON OF iNCOME TAx wiThhELD ON GAMiNG wiNNiNGs
DR 1101 (09/30/09)
Mail reconciliation together with payment (if applicable) to: Colorado Department of Revenue, 1375 Sherman St., Denver, Colorado 80261-0009
1010-130
13
Account no.
RepoRt foR YeAR
due dAte
1 Total Colorado income tax withheld per
W-2Gs.
Signed under penalty of perjury in the second degree
Signature
Date
Phone
2 Total Colorado income taxes withheld and
remitted for calendar year indicated.
S.S. NO. 1
3 A. ADDITIONAL TAX DUE
(100)
or
S.S. NO. 2
F.E.I.N.
B. TAX OVERPAYMENT
(905)
(See instructions)
4 PENALTY
(200)
5 INTEREST
(300)
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
6 Total AMOUNT PAID with this report
(355)
the payment amount directly from your bank account electronically.
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