DR 5714 (05/20/14)
Department Use Only
COLORADO DEPARTMENT OF REVENUE
Tax Files - Room 136
Processed By
P.O. Box 17087
Denver, CO 80217-0087
Section
Request For Copy of Tax Returns
Date Processed
(MM/DD/YY)
(See Instruction Sheet For Important Information)
Last Name or Business Name
First Name
Middle Initial
Address
City
State Zip
In Accordance With The Provisions of C.R.S. 39-21-113, I Hereby Request That The Department of Revenue Prepare:
For Tax Period
Tax Return (Form Number)
Tax Period Ending
Beginning
A Copy of:
(For Personal or Non-Legal Use)
A Certified Copy of:
(If Required for Legal Use or
Medical Marijuana Red Card)
Proof of Filing Return for
Identity Application:
Refund Amount
For Tax Year
A Copy of a Cashed Refund Check
Taxpayer Last Name
First Name
Middle Initial
Current Address
City
State Zip
Social Security or Account Number(s)
Phone Number
Signature and Notarization Required To Process Request
I declare under the Penalty of perjury in the second degree that I subscribed and filed said tax return(s) either for myself or
for the taxpayer named above as an officer of the company or an authorized representative thereof and that the signature
which appears on the tax return and the one that appears below are both my signatures.
Signature of Requester
Spouse’s Signature (if joint)
Date
(MM/DD/YY)
Subscribed and sworn to or affirmed before me this _____Day of ________________________________,20______In the County of
___________________ State of_______________________.
Signature of Notary
My Commission Expires
SEAL
Please do not remit any payment with this request. The first 10 pages will be provided free of charge. Subsequent pages
cost $0.25 per page. If payment is required you will be notified prior to your request being processed.