Form 104 - Colorado Individual Income Tax - 2013 Page 3
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2
3FORM 104 (03/11/14)
*130104==39999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
44. Military Family Relief Fund
44
0 0
45. Colorado Cancer Fund
45
0 0
46. Make-A-Wish Foundation of Colorado Fund
46
0 0
47. Unwanted Horse Fund
47
0 0
48. Goodwill Industries Fund
48
0 0
49. Families in Action for Mental Health Fund
49
0 0
50. Colorado Multiple Sclerosis Fund
50
0 0
51. Public Education Fund
51
0 0
52. Subtotal, add lines 36 through 51
52
0 0
53. Refund, subtract line 52 from line 35 (see page 11)
53
0 0
Direct
Type:
Checking
Routing Number
Savings
Deposit
Account Number
For questions regarding CollegeInvest direct deposit or to open an account call 800-448-2424 or visit
Amount You Owe
54. Net Tax Due, subtract line 33 from line 25 (include the subtotal from line 52)
54
0 0
55. Delinquent Payment Penalty (see instructions)
55
0 0
56. Delinquent Payment Interest (see instructions)
56
0 0
57. Estimated Tax Penalty (see instructions)
57
0 0
58. Amount You Owe, add lines 54, 55, 56 and 57
58
0 0
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 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.
We strongly recommend that you file using Revenue Online or another electronic method.
If you cannot e-file, mail to: Colorado Department of Revenue, Denver CO 80261-0005
Third Party Designee
Do you want to allow another person to discuss this
return and any other information related to this return
No
Yes. Complete the following:
with the Colorado Department of Revenue?
Designee’s Name
Phone Number
(
)
Sign Below
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return is true, correct, and complete.
Your Signature
Date
(MM/DD/YY)
Spouse Signature. If joint return, BOTH must sign.
Date
(MM/DD/YY)
Paid Preparer’s Name
Paid Preparer’s Phone
(
)
Paid Preparer’s Address
City
State
Zip
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