Form Dr 8453p - State Of Colorado Partnership/s-Corp Income Tax Declaration For Electronic Filing - 2015 Page 2

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DR 8453P (08/13/15)
*158453P=19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0006
State of Colorado Partnership/S-Corp
Income Tax Declaration for Electronic Filing
When feasible attach in PDF
format to your e-filed return
Do not mail this form to the IRS
or the Colorado Department of Revenue
(MM/DD/YY)
(MM/DD/YY)
Tax Year Beginning
Tax Year End
Retain with your records
01/01/15
01/01/15
Business Name
Colorado Account Number
SASLADJALKDJAL
23131312
Street Address
FEIN
234242342
324 Dasjlakdjaldkja
ZIP
Phone Number
City
State
(
)
Xsakdjalkdjasdiao
CO
89704-5678
303 999-8888
Part I — Tax Return Information
1. Total Income, from federal Schedule K
34343.45
1 $
2. Allowable deductions from federal Schedule K
234.67
2 $
3. Colorado Tax, line 12 on Colorado Form 106, if applicable
354345.67
3 $
4. Colorado Payments, line 18 on Colorado Form 106
989898.45
4 $
5. Amount You Owe, line 28 on Colorado Form 106
23456.67
5 $
6. Refund, line 31 Colorado Form 106
67678.78
6 $
Part II — Declaration of Tax Payer
Under penalties of perjury, I declare that I am an officer of the company listed above and the information provided for electronic filing
and the amounts shown in Part I above agree with the amounts shown on the company's 2015 Federal/Colorado income tax returns,
and that said tax returns, statements, schedules and attachments are true, correct, and complete to the best of my knowledge and
belief. I understand that I (or my Electronic Return Originator (ERO) if applicable) may be required to provide paper copies of this
declaration, my returns, withholding statements, schedules and attachments upon request by the Colorado Department of Revenue at
any time during the period covered by the Colorado statute of limitations.
(MM/DD/YY)
Signature
Date
Title
01/01/15
Saskdjalkdalkda
Part III — Declaration of ERO/Preparer/Transmitter
If the transmitter did not prepare the tax return, check here
If I am not the preparer, I declare only that the amounts shown in Part I above agree with the amounts shown on the taxpayer's 2015
Federal/ Colorado income tax returns. If I am the preparer, under penalties of perjury I declare that I have reviewed the above taxpayer's
2015 Federal/Colorado income tax returns and that the information provided to me by the taxpayer and the amounts shown in Part I above
agree with the amounts shown on said tax returns, and that said tax returns, statements, schedules, and attachments are true, correct, and
complete to the best of my knowledge and belief. As preparer, I further declare that I have obtained the taxpayer's signature on this form at
the time of filing and have provided the taxpayer with copies of all forms and information filed. I also agree to maintain this signed Form (DR
8453P) for the period covered by the Colorado statute of limitations, and to provide paper copies of this declaration, said returns, withholding
statements, schedules, and attachments upon request by the Colorado Department of Revenue at any time during this period.
ERO's Signature
Preparer Identification
Number or Your SSN
Date
(MM/DD/YY)
Check if also Preparer
01/01/15
34242442

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