Form Dr 1318 - Unlicensed Child Care Organization Registration Application Page 2
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2DR 1318 (09/01/04)
COLORADO DEPARTMENT OF REVENUE
TAXPAYER SERVICE DIVISION
DENVER, COLORADO 80261
UNLICENSED CHILD CARE ORGANIZATION REGISTRATION APPLICATION
Organization Name
Do you have a Dept of Revenue Account Number?
Yes
No
If Yes, Account # ________________________________________
Indicate Type of Organization
Individual
Limited Liability Partnership
S Corporation
Trust
General Partnership
(LLP)
Association
Non-profit 501(C)(3)
Limited Partnership
(Please enclose copy of the
Limited Liability Limited
Estate
IRS letter of exemption.)
Limited Liability Company
Partnership (LLLP)
Government
Other Non-profit
(LLC)
Corporation
Joint Venture
Other
Trade Name/Doing Business As (if applicable)
Federal Employer Identification Number (FEIN)
Street Address of Principal Place of Business in Colorado
County
City
State
ZIP Code
In Care Of (C/O)
Mailing Address (it Different From Above) (Include Unit #)
City
State
ZIP Code
Telephone Number
(
)
Check One
Register an unlicensed child care program.
Register a grant or loan program for parents in Colorado requiring financial assistance for child care.
Register a training program for child care providers.
Register an information dissemination program in Colorado to provide information and referral services to assist parents in obtaining child care.
Explanation
1. Explain why donations to this organization qualify for the child care contribution credit. ______________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
2. Do all of your programs qualify for the credit?
Yes
No If not, specify which programs do qualify. _______________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
3. Why is a Department of Human Services license not required? ________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Attach copies of brochures, newspaper articles, community publications and other documentation to support the information above.
I declare under penalty of perjury in the second degree that the statements made in this application are true and complete to the
best of my knowledge.
Name Of Organization Officer
Title
Signature Of Organization Officer
Date
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Parent category: Financial