Form 104 - Colorado Individual Income Tax - 2011 Page 3
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24Departmental Use Only
2011
FORM 104
(0013)
COLORADO INDIVIDUAL INCOME TAX
FULL-YEAR RESIDENT(S)
RESIDENCY
PART-YEAR RESIDENT(S) OR NONRESIDENT(S)
STATUS
(or resident, part-year, nonresident combinations)
(CHECK ONE)
ABROAD ON DUE DATE
For calendar year 2011 or fiscal year _____________
LAST NAME
FIRST NAME AND INITIAL
DECEASED
SOCIAL SECURITY NUMBER
Yourself
YES
Spouse, if joint
YES
Mailing Address
Your telephone number
(
)
City
State
ZIP Code
Email Address
ROUND TO THE NEAREST DOLLAR
1. ENTER FEDERAL TAXABLE INCOME from your federal income tax return: 1040EZ line 6;
00
1040A line 27; 1040 line 43 .......................................................................................................................
1
ADDITIONS
2. STATE ADDBACK enter the state income tax deduction from your federal 1040
00
schedule A (see instructions) ....................................................................................................................
2
00
3. OTHER ADDITIONS, explain (see instructions) ........................................................................................
3
00
4. Subtotal, add lines 1–3 ................................................................................................................................ 4
SUBTRACTIONS
00
5. STATE INCOME TAX REFUND enter the state income tax refund from line 10 of your federal 1040 ......
5
00
6. US GOVERNMENT INTEREST ................................................................................................................
6
00
7. PRIMARY TAXPAYER PENSION/ANNUITY income (Beneficiaries, list deceased’s SSN: ____________)
7
00
8. SPOUSE PENSION/ANNUITY income, if any (Beneficiaries, list deceased’s SSN: ____________) ......
8
00
9. COLORADO SOURCE CAPITAL GAIN 5-year assets acquired on or after 5/9/1994 ..............................
9
10. TUITION PROGRAM CONTRIBUTION:
Total Contribution $_______________________
00
Owner’s Name _____________________
Owner’s SSN ___________________ (see instructions) . 10
00
11. QUALIFYING CHARITABLE CONTRIBUTION
Total Contributions $ ___________________ ............... 11
12. OTHER SUBTRACTIONS, check appropriate box:
PERA contribution made in 1984–1986;
DPSRS contributions made in 1986;
tier I or II railroad benefits;
qualified reservation income
00
wildfire mitigation measures. ................................................................................................................. 12
00
13. Subtotal, add lines 5 through 12 .................................................................................................................. 13
00
14. COLORADO TAXABLE INCOME, line 4 minus line 13 ............................................................................. 14
CALCULATE YOUR TAX: FULL-YEAR RESIDENTS TURN TO PAGE 22 PART-YEAR RESIDENTS AND NONRESIDENTS GO TO 104PN
TAX, PREPAYMENTS AND CREDITS
00
15. COLORADO TAX from tax table or 104PN line 36 ............................................................... 15
00
16. ALTERNATIVE MINIMUM TAX from Form 104AMT ............................................................ 16
00
17. RECAPTURE of prior year credits........................................................................................ 17
00
18. Subtotal, add lines 15 through 17 ............................................................................................18
00
19. NON-REFUNDABLE CREDITS from 104CR line 49, cannot exceed the sum of lines 15 + 16 . 19
00
20. NET TAX, subtract line 19 from line 18....................................................................................20
00
21. COLORADO INCOME TAX WITHHELD from W-2 and 1099 statements ............................ 21
22. ESTIMATED TAX enter the sum of payments and credits and amounts withheld from
00
nonresident real estate sales and partnership/S corp/fiduciary income ............................... 22
00
23. REFUNDABLE CREDITS from 104CR line 9....................................................................... 23
00
24. Subtotal, add lines 21 through 23 ............................................................................................24
25. FEDERAL ADJUSTED GROSS INCOME from your federal income tax return:
00
1040EZ line 4; 1040A line 21; 1040 line 37 .......................................................................... 25
00
26. OVERPAYMENT, if line 24 is greater than 20 then subtract line 20 from line 24 ....................26
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