Form Dr 0021pd - Attach To Form Dr 0021 - Detail Information For Producers

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Dr 0021PD (08/04/08)
coloraDo DEPartmEnt oF rEVEnuE
Page _____ of _____
DENVER CO 80261-0007
DEtail inFormation
For ProDucErs
Please round dollars
to whole dollars.
(attach to Form Dr 0021)
For tax year beginning _____________________ , 20 ____ ending ______________________, 20 ____
Taxpayer’s Name
Social Security or Colorado Account No.
Production
(A)
(B)
(C)
(D)
(I)
(J)
(K)
(L)
Transportation
Source of Income: Well,
API
Royalty or Work-
% of Owner-
Barrels of Oil
MCF Gas
Processing and
Ad Valorem
Gross Income
Lease, Field or Payor
Number
ing Interest
ship
(G
Manufacturing
Tax
(E
(F)
(H)
) Gross
Exempt
) Gross
Exempt
totals
Form DR 0021PD Instructions: If a taxpayer elects to enter information for a unit or communitization agreement on the Form DR 0021PD instead of well information,
they must include a supplemental schedule detailing the individual well information including well name, API well number, production volumes, exempt production
volumes, royalty or working ownership interest, ownership percentage gross value, ad valorem tax and gross income.

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