Departmental Use Only
DR 0251 (06/10/16)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0013
(303) 238-SERV (7378)
RTA Consumer Use Tax Return
*160251==19999*
0395-100
Period Covered
Account Number
FEIN
SSN
(MM/YY-MM/YY)
–
Purchaser/Business Name
Address
City
County
State Zip
If out-of-state taxpayer, provide Colorado address
Street Address
City
County
State Zip
Signed under penalty of perjury in the second degree
Signature
Date
Phone Number
(MM/DD/YY)
1a. Purchase invoices covering the tangible property included in this return. Attach a separate sheet of paper if necessary.
Invoice
Name of Vendor
Address
Amount
Date
(MM/DD/YY)
Check here if this is an
amended return
1b. Total from attachments
2. Write in name of RTA District here: See schedules provided.
3. Taxable Amount: Add lines 1a and 1b.
00
4. Tax Rate (Refer to RTA schedules or DR 1002)
5. Net Tax Due: Multiply line 3 by line 4.
00
(100)
6. Penalty
00
(200)
Paid by EFT
7. Interest & Penalty-Interest
00
(300)
$
. 00
8. Amount Owed: Add lines 5, 6 and 7. Pay this amount with your return.
(355)
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.