Form Dr 1316 - Colorado Source Capital Gain Affidavit

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*131316==19999*
DR 1316 (08/30/13)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Colorado Source Capital Gain Affidavit
This form must be completely and accurately filled out to avoid requests for additional information and/or delays in
processing your refund.
Taxpayer Last Name
First Name
Middle Initial
SSN or Colorado Account Number
Spouse Last Name (if applicable)
First Name
Middle Initial
SSN
Provide the following information for each asset that qualifies under the requirements of the Colorado capital gain
subtraction. Include any assets that resulted in a capital loss. Attach federal schedules and/or detailed explanation if
needed. Attach additional sheets if needed.
A. Provide a brief description of the nature of the capital gains(s). Include complete address of real property.
1. ________________________________________________________
2. ________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
B. If the gain is due to an installment sale, give the date of the original sale and attach a copy of federal Form
6252 to this form.
Note: If the sale was prior to 1999, it does not qualify for the capital gain subtraction.
1.
2.
C. If the gain is due to the sale of stock, list the qualifying property and payroll factors of the corporation for the
most recent five years. Beginning 1/1/2010, the sale of stock and/or ownership interest does not qualify.
1.
2.
Year
Year
Year
Year
Year
Year
Year
Year
Year
Year
Property
Property
Property
Property
Property
Property
Property
Property
Property
Property
%
%
%
%
%
%
%
%
%
%
Payroll
Payroll
Payroll
Payroll
Payroll
Payroll
Payroll
Payroll
Payroll
Payroll
%
%
%
%
%
%
%
%
%
%
D. If the gain is being passed through from another entity, list the name and account number of the
pass-through entity and the length of time the taxpayer had ownership interest in the entity.
1. Entity
2. Entity
Account Number
Ownership Interest (length of time)
Account Number
Ownership Interest (length of time)
E. Additional Information (must be completed)
Note: When the sale of a sole proprietorship or business interest is treated as a sale of assets on the federal return, you
must report the assets sold on this form (attach additional pages if necessary). Each asset must meet the capital gain
subtraction requirements to qualify. Intangibles such as goodwill do not qualify.
(b) Date Acquired
(c) Date Sold
(e) Cost or
(a) Property
(d) Sale Price
(f) Gain or loss
(mm/dd/yyyy)
(mm/dd/yyyy)
other basis
1.
$
00 $
00 $
00
2.
$
00 $
00 $
00
3. Total Gain or (Loss)
$
00
4. Net Capital Gain or (Loss) as reported on federal Form 1040 or 1040A
$
00

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