Form Dr 0107 - Colorado Nonresident Partner, Shareholder Or Member Agreement - 2012

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DR 0107 (09/12/12)
Web
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0006
2012 Colorado Nonresident Partner, Shareholder or Member Agreement
Taxable Year of Pass-Through Entity:
Beginning ____/____/2012 Ending ____/____/20___
Taxable Year of Partner, Shareholder or Member:
Beginning ____/____/2012 Ending ____/____/20___
Name and Address of Nonresident partner
Name and Address of Pass-Through Entity
or Shareholder or Member
Name
Name
Street or Mailing Address
Street or Mailing Address
City, State, ZIP
City, State, ZIP
Social Security or Colorado Account Number
Colorado Account Number
Federal Number (FEIN)
I agree to file a 2012 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
Submit this agreement when filing the Colorado Form 106
Forms DR 0107 and DR 0108 are to be used with respect to nonresident partners, shareholders or members of a
pass-through entity. See Form 106 for additional information. Photocopy this form as needed.
Cut here and send only the coupon below. Help us save time and your tax dollars.
0018
DR 0108 (08/28/12) Web
DR 0108 (08/28/12)
2012 Statement of Colorado Tax Remittance for
COLORADO DEPARTMENT OF REVENUE
Nonresident Partner, Shareholder or Member
70
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Enter on form
DR 0108 the name and Social Security number or FEIN of the nonresident partner, shareholder or member who will ultimately claim this payment.
Please read publication FYI Income 54 before filing the DR 0108. Do not send cash. Enclose, but do not staple or attach, your payment with this
voucher.
Shareholder is (mark one):
Name of nonresident partner, shareholder or member (Last Name, First Name, MI)
Social Security Number
Individual
Address
Federal Employer ID Number
Estate or Trust
City
State
ZIP
Do not use this form for a C-Corporation or
Partnership / S-Corp / LLC
Name of Pass-Through Entity
Colorado Account Number
Federal Employer Identification Number
Address
City
State
ZIP
IF NO PAYMENT IS DUE, DO NOT FILE THIS FORM.
1. Colorado-source income for
The State may convert your check to a one time electronic banking transaction. Your bank account may
nonresident partner or shareholder
$
.00
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
2. Colorado tax remitted,
the payment amount directly from your bank account electronically.
4.63% of amount on line 1
(08)
.00
$
(Do not write in space below)

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