Form 104x - Amended Colorado Individual Income Tax Return - 2016
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DR 0104X (09/13/16)
COLORADO DEPARTMENT OF REVENUE
(0015)
Form 104X Amended Colorado
Individual Income Tax Return
2016
*160104X=19999*
Reason for amended return (mark one)
From tax year ending
(YYYY)
Investment credit carryback
Other, attach explanation
From tax year ending
(YYYY)
Federal net operating loss carryback
Changing filing status
From tax year ending
(YYYY)
Federal net capital loss carryback
Changing residency status
Protective claim, attach explanation
Your Last Name
Your First Name
Middle Initial
Date of Birth
SSN
(MM/DD/YYYY)
Deceased
State of Issue
Last 4 characters of ID number Date of Issuance
Enter the following information from your current
driver license or state identification card.
If Joint, Spouse’s Last Name
Spouse’s First Name
Middle Initial
Date of Birth
Spouse’s SSN
(MM/DD/YYYY)
Deceased
State of Issue
Last 4 characters of ID number Date of Issuance
Enter the following information from your
spouse’s current driver license or state
identification card.
Mailing Address
Phone Number
(
)
City
State
Zip Code
Foreign Country (if applicable)
Staple W-2s and 1099s here. Use only for line 16
As Amended
1. Enter Federal Taxable Income from 1040EZ line 6, 1040A line 27, 1040
line 43 or 1040X line 5
1
00
2. State Addback, enter the state income tax deduction from your federal
Form 1040 schedule A, line 5 (see instructions)
2
00
3. Other Additions, explain (see instructions)
3
00
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