Form Dr 0104ep - Individual Estimated Income Tax - 2016 Page 2
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1
2Departmental Use Only
DR 0104EP (06/02/15)
(0012)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0008
2016 Colorado Estimated Income
*160104EP19999*
Tax Payment Form
Colorado Estimated Tax – Individuals Worksheet
1. Estimated 2016 Colorado taxable income
00
$
2. Estimated 2016 Colorado income tax — 4.63% of line 1
00
$
3. Estimated 2016 Colorado alternative minimum tax
00
$
4. Estimated 2016 recapture of prior year credits
00
$
5. Total of lines 2, 3 and 4
00
$
6. Estimated 2016 Form 104CR credits
00
$
7. Line 5 minus line 6
00
$
8. Estimated 2016 Colorado withholding tax
00
$
9. Net estimated tax, line 7 minus line 8
00
$
Payment Number
Net Amount Due
2015 Overpayment Applied
Payment Due
Due Dates
1
April 18
$
$
$
2
June 15
$
$
$
September 15
3
$
$
$
4
January 15, 2017
$
$
$
Round your payment to the nearest dollar. If paying by check, the amount on the check and the amount entered on the
payment form must be the same. This will help maintain accuracy in your tax account. It is strongly recommended that
estimated payments be submitted online at or by EFT at
to avoid problems or delays with the 2016 income tax return.
Due Dates: If the due date falls on a weekend or federal holiday, payment will be due the next business day.
DR 0104EP (05/28/15)
Return the DR 0104EP with check or money order payable to the Colorado Department of Revenue, Denver, Colorado
80261-0008. Write your Social Security number and “2016 DR 0104EP” on your check or money order. Do not send
cash. Enclose, but do not staple or attach, your payment with this form. File only if you are making a payment of
estimated tax and are unable to pay online or by EFT.
Middle Initial SSN
Your Last Name
First Name
Spouse’s Last Name
Middle Initial Spouse SSN
First Name
State Zip
Address
City
Amount of Payment
The State may convert your check to a one time electronic banking transaction. Your
If No Payment Is Due, Do Not File This Form.
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
$
.00
due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
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