Form Dr 0096 - Request For Tax Status Letter - Colorado Department Of Revenue
ADVERTISEMENT
1DR 0096 (07/02/10)
COLORADO DEPARTMENT OF REVENUE
TAXPAYER SERVICE DIVISION
1375 SHERMAN STREET
DENVER CO 80261
(303) 238-SERV (7378)
REQUEST FOR TAX STATUS LETTER
In accordance with the provisions of § 38-25.5, C.R.S., I hereby request that the Department of Revenue issue a tax
status letter.
Name of Taxpayer/DBA
Location Address
City
State
ZIP
Mailing Address
City
State
ZIP
Colorado Account Number(s)
FEIN
Telephone No.
TyPE OF TAXES
List only taxes that are remitted to the Colorado Department of Revenue.*
Corporate Income
Consumers Use
SCFD Sales
County Sales
State Sales
State Witholding
Football Sales
Retailers Use
City Sales
RTD Sales
Baseball Sales
Severance
Make Check Payable To: Department of Revenue
Fee: $7.00 per Tax
To Be Paid Before Issuance of the Clearance.
$
Total Remitted
Send TOP copy to the Department of Revenue
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
2700
uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically
* Tax status letters are not available for individual income tax. DO NOT send this form or payment as a request for an
individual income tax status letter.
If liability for any other tax exists and reports have not been filed, the tax may be assessed at any time. The issuance
of this letter does not fix, abate, modify, or cancel any liability or payment of money due or performance of an obligation
to the State of Colorado.
I declare under the penalty of perjury in the second degree that I am a duly authorized officer of the corporation for
which this tax status letter is requested and that I am acting in my official capacity in making this request.
Authorization/Power of Attorney must be attached to this request if applicable.
Name
Title
Signature
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial