Form Dr 0021 - Colorado Severance Tax - Oil And Gas - 2013
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1
2Departmental Use Only
DR 0021 (08/28/13)
Colorado
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0006
Severance Tax–Oil and Gas
(7001)
DR 0021
2013
*130021==19999*
-or-
Fiscal Year Beginning
Ending
(MM)
(MM/YY)
, 2013
Last Name (or Corporation Name)
First Name
Middle Initial
Date Deceased
SSN
Colorado Account Number
(MM/DD/YY)
Deceased
Yes
Spouse Last Name (see controlled group definition)
Spouse First Name
Middle Initial
Date Deceased
SSN
Colorado Account Number
(MM/DD/YY)
Deceased
Yes
Address
FEIN
City
State
ZIP
Telephone
(
)
If this is a final return check this box
Are you a producer of Colorado Oil or Gas?
Yes
No
Tax and Credit – Complete schedule DR 0021D first. Attach the DR 0021D to this form
Round To The
when you file
Nearest Dollar
•
1. Oil and gas tax, enter amount from line 5, DR 0021D
1
00
•
2. Impact assistance credit
2
00
3. Net tax, line 1 minus line 2 but not less than zero
3
00
Prepayments
•
4. Severance tax withheld, attach form DR 0021W
4
00
•
5. Estimated tax and extension payments
5
00
6. Total prepayments, add lines 4 and 5
6
00
Refund
7. If line 6 is larger than line 3, enter your overpayment
7
00
•
8. Enter amount from line 7 you want refunded
8
00
•
9. Enter amount from line 7, if any, you want credited to estimated tax for next year
9
00
Direct
Type:
Checking
Savings
Routing Number
Deposit
Account Number
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Parent category: Financial