Form Dr 0021x - Amended Colorado Oil And Gas Severance Tax Return - 2011
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1
2For Department Use Only
DR 0021X (10/17/11)
COLORADO DEPARTMENT OF REVENUE
DENVER CO 80261-0007
(7102)
Amended Colorado Oil and
gas severance Tax Return
For taxable year beginning ______________, 20 _______Ending _______________, 20_______.
Last Name (or Corporation Name)
First Name and Middle Initial
Deceased
Yourself
Social Security Number or Colorado Account No.
YEs
Your Spouse (see controlled group definition)
Spouse’s Social Security Number
YEs
Address
Federal Employer ID Number
City
State
ZIp Code
Telephone
(
)
If this is a final return check this box
Are you a producer of Colorado Oil or gas?
YEs
NO
ROUND TO ThE NEAREsT DOLLAR
TAX and CREDiT — Complete schedule DR 0021D first. Attach the DR 0021D to this form when you file.
•
00
1. Oil and gas tax, enter amount from line 5, DR 0021D ..................................................
1
•
00
2. Impact assistance credit ................................................................................................
2
3. Net tax, line 1 minus line 2 but not less than zero ........................................................... 3
00
PREPAYMENTs
•
4. Severance tax withheld, attach forms DR 0021W .............................................................
00
4
•
00
5. Estimated tax and extension payments ......................................................................
5
6. Total prepayments, add lines 4 and 5 ........................................................................... 6
00
stop here to let the department calculate your refund or balance due. Otherwise, manually complete the return yourself
and continue with line 7.
•
00
7. If line 6 is larger than line 3, enter your overpayment .................................................
7
•
00
8. Enter the overpayment from your original return or as previously adjusted ................
8
•
9. If line 3 is larger than line 6, enter the amount owed ..................................................
00
9
•
10. Enter the amount owed from your original return or as previously adjusted ...............
10
00
COMPUTE ThE AMOUNT YOU OWE
00
11. Line 8 minus line 7, but not less than zero .................................................................... 11
00
12. Line 9 minus line 10, but not less than zero .................................................................. 12
00
13. Additional tax due, total of lines 11 and 12 .................................................................... 13
•
00
14. Interest due on additional tax ......................................................................................
14
•
00
15. penalty due ................................................................................................................
15
•
00
16. Estimated tax penalty due ..........................................................................................
16
•
17. Payment due with this return, add lines 13 through 16 .....................
00
paid by EFT
17
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.
COMPUTE YOUR REFUND
18. Line 7 minus line 8, but not less than zero .................................................................... 18
00
19. Line 10 minus line 9, but not less than zero .................................................................. 19
00
•
20. Refund claimed with this return, total of lines 18 and 19
20
00
(Do not include this amount on line 20)
•
21. Overpayment credited to next year’s estimated tax ....................................................
21
00
Savings
Type:
Checking
Routing number
Account number
REAsON FOR AMENDMENT:
MAiL TO AND MAKE ChECKs PAYABLE TO: Colorado Department of Revenue, Denver, CO 80261-0007
Under penalty of perjury in the second degree, I declare that I have examined this return and to the
Name, address and telephone number of person
best of my knowledge and belief it is true, correct, and complete.
preparing return
Signature of Individual Taxpayer
Date
Spouse’s Signature
Date
Signature of Corporate Officer
Date
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