Form Dr 0021d - Colorado Oil And Gas Severance Tax Schedule - 2012
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1DR 0021D (08/31/12)
Web
COLORADO DEPARTMENT OF REVENUE
Colorado Oil And Gas
Denver CO 80261-0007
Severance Tax Schedule
Page _____ of _____
(Attach to Form DR 0021)
Please round dollars
to whole dollars.
For tax year beginning _______________________, 20____ ending _____________________, 20 ____
Taxpayer’s Name
Social Security or Colorado Account Number
(A)
(B)
(C)
(D)
(E)
(F)
(G)
Producer Name
Gross Income
Gross Income
Net Gross Income
Ad Valorem
Ad Valorem
Net Ad Valorem
List each 0021W on a
Attributable to
(Column B-C)
Attributable to
(Column E-F)
Separate Line
Stripper Well
Stripper Well
Production
Production
Check Accounting Method
cash-basis or
accrual basis
•
1. Net gross income [total of column (D)] ............................................................................
1
00
•
2. Tax on total net gross income (see tax rate schedule below) ......................................
2
00
•
3. Net ad valorem tax [total of column (G)] ............................
3
00
•
4. Ad valorem tax credit, 87.5% of the amount on line 3 ..................................................
4
00
5. Net tax on oil and gas income, line 2 minus line 4. If line 4 is larger enter 0.
Enter here and on line 1 of form DR 0021 ........................................................................ 5
00
Tax Rate Schedule
If total net gross income is:
The tax is:
Under $25,000
2% of gross income
$25,000–$99,999
$500 plus 3% of the excess over $24,999
$100,000–$299,999
$2,750 plus 4% of the excess over $99,999
$300,000 and over
$10,750 plus 5% of the excess over $299,999
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