Form Dr 0021pd - Detail Information For Producers (2012) printable pdf download

Form Dr 0021pd - Detail Information For Producers (2012)

Vendor ID

Detail Information For Producers

Web

DR 0021PD (08/31/12)

COLORADO DEPARTMENT OF REVENUE

Page _____ of _____

Denver, CO 80261-0007

(Attach to DR 0021)

Please round dollars

to whole dollars.

For tax year beginning ________________________, 20 ____ ending _______________________, 20 ____

Taxpayer’s Name

Social Security or Colorado Account Number

(A)

(B)

(C)

(D)

(I)

(J)

(K)

(L)

Production

Source of Income: Well,

API

Royalty or Working

% of Owner-

Transportation

Processing and

Ad Valorem Tax

Gross Income

Barrels of Oil

MCF Gas

Lease, Field or Payor

Number

Interest

ship

Manufacturing

(E) Gross (F) Exempt (G) Gross

(H) Exempt

Totals

DR 0021PD Instructions: If a taxpayer elects to enter information for a unit or communization agreement on the DR 0021PD instead of well information, they must

include a supplemental schedule detailing the individual well information including well name, API well number, production volumes, exempt production volumes,

royalty or working ownership interest, ownership percentage gross value, ad valorem tax and gross income.