Form Dr 0020ax - Amended Colorado Metallic Minerals Severance Tax Return - 2011 Page 2
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2
3•
22. Payment due with this return, add lines 18 through 21 .....................................
Paid by EfT
22
00
The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will
not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
COMPUTE YOUR REfUND
23. Line 12 minus line 13, but not less than zero..................................................................................... 23
00
24. Line 15 minus line 14, but not less than zero..................................................................................... 24
00
•
25. Refund claimed with this return, total of lines 23 and 24 ................................................................
25
00
Checking
Routing number
Type:
Savings
Account number
•
26. overpayment credited to next year's estimated tax ......................................................................
26
00
REASON fOR AMENDMENT:
Name, address and telephone number of
Under penalty of perjury in the second degree, I declare that I have examined this return and to the
best of my knowledge and belief it is true, correct, and complete.
person preparing return:
Signature of Taxpayer or Corporate Officer
Date
MAIL TO AND MAke CheCkS PAYAbLe TO:
Colorado Department of Revenue
Denver, CO 80261-0007
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