Form 104 - Colorado Individual Income Tax - 2015 Page 4

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*150104V249999*
FORM 104 (11/16/15)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Name
Account Number
Modified AGI Tiers for State Sales Tax Refund
$36,001 –
$77,001 –
$120,001 –
$163,001 –
$204,001 –
If line 25 is:
$36,000 or less
$77,000
$120,000
$163,000
$204,000
or more
Single Filers Enter
$13
$18
$21
$23
$24
$41
Joint Filers Enter
$26
$36
$42
$46
$48
$82
46. State Sales Tax Refund: For full-year Colorado residents, born before 1997, or full-year
Colorado residents who are under the age of eighteen but are required to file a return. Use
the amount on line 25 and reference the table above. See instructions if you are filing an
extension.
46
0 0
47. Subtotal, add lines 38 through 46
47
0 0
48. Overpayment, if line 47 is greater than 37 then subtract line 37 from line 47
48
0 0
49. Estimated Tax Credit Carry Forward to 2016 first quarter, if any
49
0 0
Voluntary Contributions enter your donation amount, if any
50. Nongame and Endangered Wildlife Cash Fund
50
0 0
51. Colorado Domestic Abuse Program Fund
51
0 0
52. Homeless Prevention Activities Program Fund
52
0 0
53. Western Slope Military Veterans Cemetery Fund
53
0 0
54. Pet Overpopulation Fund
54
0 0
55. Military Family Relief Fund
55
0 0
56. Public Education Fund
56
0 0
57. Roundup River Ranch Fund
57
0 0
58. 9Health Fair Fund
58
0 0
59. American Red Cross Colorado Disaster Response, Readiness,
and Preparedness Fund
59
0 0
60. Colorado for Healthy Landscapes Fund
60
0 0
61. Habitat for Humanity of Colorado Fund
61
0 0
62. Special Olympics of Colorado Fund
62
0 0
63. Colorado Youth Corps Association Fund
63
0 0
64. This line reserved for future use
65. Subtotal, add lines 49 through 63
65
0 0

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