Form 104x - Amended Colorado Individual Income Tax Return - 2014 Page 2
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4Departmental Use Only
DR 0104X (10/02/14)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005
(0015)
Form 104X Amended
2014
Colorado Individual Income
*140104X=19999*
Tax Return
Reason for amended return (mark one)
From tax year ending
(YYYY)
Investment credit carryback
Other, attach explanation
From tax year ending
(YYYY)
Federal net operating loss carryback
Changing filing status
From tax year ending
(YYYY)
Federal net capital loss carryback
Changing residency status
Protective claim, attach explanation
Last Name
First Name
Date of Birth
SSN
Middle
Deceased
(MM/DD/YY)
Initial
Yes
Spouse’s Last Name, if joint
First Name
Date of Birth
SSN
Middle
Deceased
(MM/DD/YY)
Initial
Yes
Telephone Number
Mailing Address
(
)
City
State
Zip
Foreign Country (if applicable)
As Amended
1. Enter Federal Taxable Income from 1040EZ line 6, 1040A line 27, 1040 line 43
or 1040X line 5
1
00
Additions
2. State Addback, enter the state income tax deduction from your federal form
1040 schedule A, line 5 (see instructions)
2
00
3. Other additions, explain (see instructions)
3
00
4. Subtotal, add lines 1 through 3
4
00
Subtractions
5. State Income Tax Refund from federal income tax form: enter $0 filing 1040EZ
or 1040A; 1040 line 10.
5
00
Staple W-2s and 1099s here.
6. U.S. Government Interest
Use only for line 27.
6
00
7. Primary Taxpayer Pension/Annuity Income
Deceased SSN:
7
00
8. Spouse Pension/Annuity Income
Deceased SSN:
8
00
9. Colorado Source Capital Gain; 5-year assets acquired on or after 5/9/1994
9
00
Total Contribution
10. Tuition Program Contributions (see instructions)
$
Owner’s Name
Owner’s SSN:
10
00
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