Form Dr 0021sa - Extension Payment Voucher For Colorado Metallic Minerals Severance Tax Return

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DR 0021SA (10/26/11)
cOLOrADO DepArtmeNt Of reveNUe
DEnvER CO 80261-0008
extension of time for filing colorado
metallic minerals severance tax return
Use the DR 0021SA to make a payment that must be made
Colorado severance tax returns are due to be filed 3½ months
by the original due date of the return to meet the 90%
after the close of the tax year.
requirement.
An automatic six-month extension of time for filing the
If after the original due date of the return it is found that the
Colorado severance tax return is allowed for all taxpayers.
amount paid is insufficient to meet the 90% requirement,
However, an extension of time to file is not an extension
additional payment should be made as soon as possible
of time to pay the tax. If at least 90% of the net tax liability
to reduce accumulation of penalty and interest. Make such
is not paid by the original due date of the return, penalty
payment on the DR 0021SA.
and interest will be assessed. If 90% or more of the net tax
liability is paid by the original due date of the return and the
Be sure to round your payment to the nearest dollar. You must
balance is paid when the return is filed by the last day of the
enter 00 after the decimal point. The amount on the check
extension period, only interest will be assessed.
and the amount entered on the payment voucher must be the
same. This will help maintain accuracy in your tax account.
Submit the DR 0021SA with payment to:
Colorado Department of Revenue
Denver, CO 80261-0008
worksheet
(rOUND tO tHe NeArest DOLLAr)
1. Tentative amount of tax for the taxable year after reduction
for the impact assistance credit (if any) .......................................................................................................$ ___________
2. Less estimated tax payments ......................................................................................................................$ ___________
3. Balance to be remitted with this request for extension, line 1 minus line 2.
Enter amount of payment below. Claim credit for this payment on line 11 of DR 0020A ............................$ ___________
If no payment is due, do not file the DR 0021SA
DETACH FORM
Photocopy for your records.
ON THIS LINE
cut here and send only the coupon below. Help us save time and your tax dollars.
(7046)
extension payment voucher for colorado
DR 0021SA (10/26/11)
metallic minerals severance tax return
16
cOLOrADO DepArtmeNt Of reveNUe
for tax period ______________________________________, 20 ___, ending: ______________________________________, 20___.
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Write your Social
Security number, Colorado Account number or Federal Employer Identification number and “DR 0021SA” on your check or money order. Do not
send cash. Enclose, but do not staple or attach, your payment with this voucher.
name
Colorado Account number
Address
Federal Employer Identification number
City
State
ZIP
IF nO PAYMEnT IS DUE, DO nOT FILE THIS FORM.
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 received
Amount of Payment
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.
$
. 0 0
(Do not write in space below)

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