Form Dr 5778 - Eft Authorization Corporate Estimated Income Tax Ach Debit/form 112ep - Corporate Estimated Tax Payment Vouchers - 2010 Page 3

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FORM 112EP (10/07/09) Web
COLORADO DEPARTMENT OF REVENUE
DEnVER, CO 80261-0008
Corporate Estimated Tax Payment Voucher
SEE FORM AT bOTTOM OF PAGE
DETACH FORM
ON THIS LINE
(0022)
Corporate Estimated Tax
Vendor ID
2010 FORM 112EP
COLORADO DEPARTMENT OF REVENUE
Payment Voucher
70
PAyMENT 2
For the calendar year 2010 or the fiscal year: Start Date:
End Date:
____________________ , 2010
_________________ .
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Write your Colorado
Account number and “2010 Form 112EP” 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.
Corporation Name
Colorado Account Number
Address
Federal Employer Identification number
City
State
ZIP
Due Date
IF NO PAyMENT IS DUE, DO NOT FILE ThIS FORM.
yOU MUST ROUND TO ThE NEAREST DOLLAR
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
AMOUNT OF PAyMENT
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.
(08)
$
.
DO NOT WRITE IN SPACE bELOW

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