Form Dr 0107 - Colorado Nonresident Partner, Shareholder Or Member Agreement - 2013
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1
22013 Colorado Nonresident
DR 0107 (08/05/13)
*130107==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0006
Partner, Shareholder or
Member Agreement
Day
Year
Day
Year
Month
Month
(DD)
(MM)
(YYYY)
(DD)
(MM)
(YYYY)
Taxable Year of Pass-Through Entity
Beginning:
Ending:
Day
Month
Year
Day
Month
Year
(DD)
(MM)
(YYYY)
(DD)
(MM)
(YYYY)
Beginning:
Ending:
Taxable Year of Partner, Shareholder or Member
Name and Address of Nonresident partner
Name and Address of Pass-Through Entity
or Shareholder or Member
Last Name
Last Name
First Name
Middle Initial
First Name
Middle Initial
Street or Mailing Address
Street or Mailing Address
City
State
Zip
City
State
Zip
FEIN
SSN or Colorado Account Number
Colorado Account Number
I agree to file a 2013 Colorado income tax return and make timely payment of all taxes imposed by the state of Colorado
with respect to my share of the Colorado income of the pass-through entity named above. I also agree to be subject to
personal jurisdiction in the state of Colorado for purposes of the collection of unpaid income tax together with related
penalties and interest.
Taxpayer's or authorized agent's signature
Date
(MM/DD/YY)
Submit this agreement when filing the Colorado Form 106
A nonresident partner, shareholder, or member can complete this form DR 0107 to establish that they will report the
Colorado source income and pay the Colorado tax on any income derived from a Colorado partnership. This form shall be
delivered by the nonresident partner to the partnership, which shall later be submitted by the partnership with Form 106.
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