Form 104 - Colorado Individual Income Tax - 2015

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Departmental Use Only
FORM 104 (11/16/15)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Colorado Individual
2015
Income Tax Form 104
(0013)
Full-Year
Part-Year or Nonresident
*150104V219999*
(or resident, part-year, non-
resident combination)
Mark if Abroad on due
date - see instructions
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
Spouse, if joint
(MM/DD/YYYY)
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.
Mailing Address
Phone number
(
)
City
State
ZIP Code
Foreign Country (if applicable)
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
0 0
Additions
2. State Addback, enter the state income tax deduction from your federal form
1040 schedule A, line 5 (see instructions)
2
0 0
3. Other Additions, explain (see instructions)
3
0 0
Explain
4. Subtotal, add lines 1 through 3
4
0 0
Staple W-2s and 1099s with CO withholding here
.

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