Form Dr 1316 - Colorado Source Capital Gain Affidavit Page 2

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*131316==29999*
Maximum subtraction is $100,000 for tax years beginning on or after January 1, 2010
5. Colorado Source Capital Gain Subtraction, enter lesser of lines 3, 4, or $100,000 for tax years
$
beginning on or after January 1, 2010. Enter here and on Form 104.
00
Qualifying Colorado Source Capital Gains and Losses
I attest that the taxpayer(s) shown above has no overdue state tax liabilities and is not in default on any contractual
obligations owed to the state or to any local government within Colorado at the time the attached income tax return is
being filed. Under penalties of perjury, I declare that to the best of my knowledge and belief, this affidavit is true, correct
and complete.
Signature, Taxpayer or Duly Authorized Individual
Date
(MM/DD/YY)
Spouse Signature (if joint return, both must sign)
Date
(MM/DD/YY)
Include a copy of federal Schedule D and/or Form 4797 with this form.

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