Form Dr 0349 - Remediation Of Contaminated Land Credit Use Schedule
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1DR 0349 (08/11/14)
*140349==19999*
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005
Remediation of Contaminated Land
Credit Use Schedule
Last Name or Business Name
First Name
Middle Initial
SSN
Colorado Account Number
FEIN
Tax Year Ending
Pass-Through Entity Name
Ownership %
Entity FEIN
Part A: Use Of Credit Complete this part if you are using or carrying forward credit on this tax return.
Credit Amount Available.
(Total credit amount available from the Remediation of Contaminated Land Certificate issued by CDPHE)
$
1. What type of taxpayer are
a.
b.
c.
d.
e. Totals
you for each credit?
(Attach additional
a transferee
a transferee
a transferee
a transferee
pages if necessary,
and only enter
overall totals on the
transferor
transferor
transferor
transferor
final page.)
originator
originator
originator
originator
2. From whom did you
receive each credit?
3. Their Social Security
Number or Federal
Identification Number
OR
4. Their Colorado Account
Number
5. Date you received the
credit
6. Total credit available
for you to use. (Enter
the total credit less the
amount transferred, OR
the amount received
through transfers).
$
$
$
$
7. Credit you used in prior
$
$
$
$
years
8. Credit available for you
to use this year, Line 6
minus Line 7. (Enter the
Total on form 104CR Line
24a, or form 112CR line
18a, if applicable.)
$
$
$
$
$
9. Credit you are using this
year. (Enter the Total on
form 104CR Line 24b, form
105 Schedule G Line 7,
form 106CR Line 13, or
form 112CR Line 18b.)
$
$
$
$
$
10. Credit carried forward
to next year, Line 8 minus
$
$
$
$
$
Line 9.
I certify that I meet the requirements of 39-22-526, C.R.S.
Date
Signature
(MM/DD/YY)
Photocopy and submit additional pages as needed.
For additional information regarding the remediation of contaminated land credit, see FYI Income 42 and the
Tax Information Index at or contact the Department of Revenue at 303-238-7378.
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