Form Dr 0021as - Colorado Severance Tax Affiliations Schedule
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1DR 0021AS (06/03/14)
*140021AS19999*
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0006
Colorado Severance Tax
Affiliations Schedule
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Name of Corporation
FEIN
Colorado Account Number
Address
Foreign Country
City
State
Zip
Attach this Schedule to your Severance Tax Return
(Submit Multiple Pages if Needed)
(see page 2 for instructions)
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