Form 104x - Amended Colorado Individual Income Tax Return - 2015 Page 2
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DR 0104X (12/04/15)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005
(0015)
Form 104X Amended
2015
Colorado Individual Income
*150104X219999*
Tax Return
Reason for amended return (mark one)
From tax year ending
(YYYY)
Investment credit carryback
Other, attach explanation
From tax year ending
(YYYY)
Federal net operating loss carryback
Changing filing status
From tax year ending
(YYYY)
Federal net capital loss carryback
Changing residency status
Protective claim, attach explanation
Last Name
First Name
Middle Initial Deceased
Date of Birth
SSN
Yourself
(MM/DD/YYYY)
State of Issue Last 4 characters of ID number Date of Issuance
Enter the following information from your current driver license or
state identification card.
Last Name
First Name
Middle Initial Deceased
Date of Birth
SSN
(MM/DD/YYYY)
Spouse, if joint
State of Issue Last 4 characters of ID number Date of Issuance
Enter the following information from your spouse’s current driver
license or state identification card.
Phone number
Mailing Address
(
)
ZIP Code
City
State
Foreign Country (if applicable)
Staple W-2s and 1099s here. Use only for line
.
38
As Amended
1. Enter Federal Taxable Income from 1040EZ line 6, 1040A line 27, 1040 line 43 or
1040X line 5
1
00
Additions
2. State Addback, enter the state income tax deduction from your federal form 1040
00
schedule A, line 5 (see instructions)
2
00
3. Other additions, explain (see instructions)
3
Explain
4. Subtotal, add lines 1 through 3
4
00
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