Form Dr 1094 - Colorado Department Of Revenue W-2 Wage Withholding Tax Return
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1
2DR 1094 ( 03/20/12 )
Web
COLORADO DEPARTMENT OF REVENUE
Denver, Colorado 80261-0009
W-2 Wage Withholding Tax Return
(Withholding from W-2 forms only)
SEE FORM AT BOTTOM OF PAGE
DETACH FORM
Photocopy for your records.
ON THIS LINE
Cut here and send only the coupon below. Help us save time and your tax dollars.
Colorado Department of Revenue W-2 Wage
DR 1094 (03/20/12) Web
DR 1094 (03/20/12)
Withholding Tax Return
COLORADO DEPARTMENT OF REVENUE
13
Account Number
Period
Due Date
FEIN
1000-100
Social Security Number 1
Social Security Number 2
1. Total Colorado tax withheld
00
from W-2s only.
(100)
2. Overpayment of tax for PRIOR
Signed under penalty of perjury in the second degree.
PERIODS OF CURRENT YEAR
00
______________________________
___________
_________________
to be subtracted from current tax. (905)
Signature
Date
Phone
00
3. Line 1 minus line 2
00
4. Penalty (see instructions)
(200)
The State may convert your check to a one time electronic banking transaction. Your bank account
00
may be debited as early as the same day received by the State. If converted, your check will not
5. Interest (see instructions) .0025 (300)
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.
6. Amount Owed
$
. 0 0
(Total of lines 3, 4, and 5)
(355)
(Do not write in space below)
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