Colorado Income Tax Filing Guide - 2013 Page 3
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28Departmental Use Only
FORM 104 (10/08/13)
COLORADO DEPARTMENT OF REVENUE
Colorado Individual
Denver, CO 80261-0005
Income Tax Form 104
2013
(0013)
Full-Year
Part-Year or Nonresident (or resident,
*130104==19999*
part-year, nonresident combination)
Mark if Abroad on
due date - see page 25
Last Name For Yourself
First Name For Yourself
Middle Initial
lkjlkjlkjlkjlj
lkkjlkjlkj
j
Date of Birth
SSN
(MM/DD/YY)
Deceased
Yes
04-25-53
345-09-8946
Last Name for Your Spouse (see controlled group definition)
First Name For Spouse
Middle Initial
k
lkjlkjlkj
;lkjl;kjlkj
Date of Birth
SSN
(MM/DD/YY)
Deceased
Yes
04-36-90
394-09-6784
Mailing Address
Phone number
(
)
kjlkjlkj
(303) 890-6785
City
State
ZIP Code
Foreign Country (if applicable)
k;lj
098
l;kjlj
l;kj
Round To The Next Dollar
1. Enter Federal Taxable Income from your federal income tax form: 1040EZ line 6;
1040A line 27; 1040 line 43
1
098098
Additions
2. State Addback, enter the state income tax deduction from your federal form
098098
1040 schedule A, line 5 (see instructions)
2
0 0
0998098
3. Other Additions, explain (see instructions)
3
0 0
098098
4. Subtotal, add lines 1 through 3
4
0 0
Subtractions
5. State Income Tax Refund from federal income tax form 1040, line 10; enter $0 if filing
098098
1040A or 1040EZ
5
0 0
098098
6. U.S. Government Interest
6
0 0
7.
Primary Taxpayer Pension/Annuity income
9 9 9 0 9 8 0 9 8
Deceased SSN:
7
0 0
098098
8.
Spouse Pension/Annuity income
9 9 9 9 9 9 9 9 9
Deceased SSN:
8
98787
0 0
9. Colorado Source Capital Gain; 5-year assets acquired on or after 5/9/1994
9
9877
0 0
10. Tuition Program Contribution: (see instructions)
9 8 7 9 8 7 9 8 7
8977
Owner’s SSN:
10
0 0
Owner’s Name
Total Contribution
987987kjhkjhkjh
987987
Total Contribution
897987
987
11. Qualifying Charitable Contribution
11
0 0
$
12. Qualified Reservation Income
987
12
0 0
13. PERA/DPSRS Subtraction, for PERA contributions made in 1984–1986 or
DPSRS contributions made in 1986
13
0 0
987
14. Railroad Benefit Subtraction, tier I or II only
987
14
0 0
15. Wildfire Mitigation Measures Subtraction
15
987
0 0
987
16. Other Subtractions, explain below (see instructions)
16
0 0
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