Form Dr 0021p - Estimated Colorado Oil And Gas Severance Tax - 2011

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Department Use Only
DR 0021P (09/23/11)
COlORADO DEPARTMEnT OF REVEnUE
Denver, CO 80261-0007
(7030)
Estimated Colorado
Oil and Gas Severance Tax
For calendar year 20________
or fiscal tax year beginning ______________, 20_______, ending ______________, 20_______
Federal Employer Identification Number
Colorado Account Number
Last Name
First Name and Middle Initial
Address
00
1. Oil and Gas Tax ............................
City
State
ZIP
00
2. Credits ...........................................
DUE DATE:
Signature of Officer or Agent
Date
3. Payment Due — Line 1
$
00
minus line 2 ..............................
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.
MAil TO AnD MAkE ChECkS PAyAblE TO: Colorado Department of Revenue
Denver, CO 80261-0007
instructions for Estimated Colorado Oil and Gas Severance Tax
Corporations that must pay Estimated Severance Tax
Every corporation subject to severance tax must pay estimated severance tax if its severance tax liability for the tax year
is expected to exceed its severance tax credits by $5,000 or more. Payments must be submitted via Electronic Funds
Transfer (EFT). A paper voucher for these tax payments is not required; the EFT transaction is the filing.
Authorization to Submit EFT Payments
If you are not currently set up to send EFT payments, you may obtain information (DR 5782) and an application
(DR 5785) at
Due Dates of Payments
Estimated tax is due on or before the 15th day of the month of the taxable year when tax is due. The corporation may
elect to prepay any installment due.
Credits
Any overpayment of severance tax from a prior month may be claimed as a credit to this month's
estimated tax.

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