Form 104x - Amended Colorado Individual Income Tax Return - 2015 Page 3
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6*150104X229999*
DR 0104X (12/04/15)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005
Name
Account Number
Subtractions
5. State Income Tax Refund from federal income tax form: enter $0 filing 1040EZ or
00
1040A; 1040 line 10.
5
6. U.S. Government Interest
6
00
7. Primary Taxpayer Pension/Annuity Income
Deceased SSN:
–
–
7
00
8. Spouse Pension/Annuity Income
Deceased SSN:
–
–
8
00
9. Colorado Source Capital Gain; 5-year assets acquired on or after 5/9/1994
9
00
10. Tuition Program Contribution: (see instructions)
Owner’s SSN:
–
–
10
00
Owner’s Name
Total Contribution
Total Contribution
11. Qualifying Charitable Contribution
$
11
00
12. Qualified Reservation Income
12
00
13. PERA/DPSRS Subtractions, for PERA contributions made in 1984-1986 or DPSRS
contributions made in 1986.
13
00
14. Railroad Benefit Subtraction, tier I or II only
14
00
15. Wildfire Mitigation Measures Subtraction
15
00
16. Colorado Marijuana Business Deduction
16
00
17. Non-Resident Disaster Relief Worker Subtraction
17
00
18. Other Subtractions
(see instructions)
18
00
Explain
19. Subtotal, add lines 5 through 18
19
00
20. Colorado Taxable Income, line 4 minus line 19
20
00
Modified AGI for TABOR
21. Federal Adjusted Gross Income from your federal income tax form: 1040EZ line 4;
1040A line 21; 1040 line 37
21
00
22. Nontaxable Social Security Income
22
00
23. Nontaxable Lump-sum Distributions from pension and profit sharing plans.
23
00
24. Nontaxable interest income from state and local bonds.
24
00
25. Sum of lines 21 through 24: Modified AGI for TABOR.
25
00
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