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state of Colorado

dr 8453P (02/23/12)

Colorado dePartMeNt of reveNUe

deNVer co 80261-0005

PartNersHIP/s-CorP INCoMe taX

deClaratIoN for eleCtroNIC fIlINg

WHeN feasIBle attaCH IN Pdf forMat to YoUr e-fIled retUrN

do Not MaIl this form to

the irs or the colorado dePartmeNt of reVeNUe

retaIN WItH YoUr reCords

tax Year

Beginning _________ 20___, ending ______20___

Name

colorado account Number

address

Federal Employer Identification Number

city

state

ZiP

telephone Number

(

)

Part I — taX retUrN INforMatIoN

1. ordinary income, from federal schedule K

2. allowable deductions from federal schedule K

3. colorado tax, line 11 on colorado form 106, if applicable

4. colorado Payments, line 17 on colorado form 106

5. amount You owe, line 24 on colorado form 106

6. refund, line 27 colorado form 106

Part II — deClaratIoN of taXPaYer

Under penalties of perjury, I declare that I am an officer of the company listed above and the information provided for electronic filing and the amounts shown

in Part I above agree with the amounts shown on the company's 2011 Federal/Colorado income tax returns, and that said tax returns, statements, schedules

and attachments are true, correct, and complete to the best of my knowledge and belief. i understand that i (or my electronic return originator (ero) if

applicable) may be required to provide paper copies of this declaration, my returns, withholding statements, schedules and attachments upon request by the

Colorado Department of Revenue at any time during the period covered by the Colorado statute of limitations.

signature

date

title

Part III — deClaratIoN of ero/PreParer/traNsMItter

(if the transmitter did not prepare the tax return, check here

)

If I am not the preparer, I declare only that the amounts shown in Part I above agree with the amounts shown on the taxpayer's 2011 Federal/

Colorado income tax returns. If I am the preparer, under penalties of perjury I declare that I have reviewed the above taxpayer's 2011 Federal/

Colorado income tax returns and that the information provided to me by the taxpayer and the amounts shown in Part I above agree with the

amounts shown on said tax returns, and that said tax returns, statements, schedules, and attachments are true, correct, and complete to the

best of my knowledge and belief. As preparer, I further declare that I have obtained the taxpayer's signature on this form at the time of filing and

have provided the taxpayer with copies of all forms and information filed. I also agree to maintain this signed Form (DR 8453P) for the period

covered by the Colorado statute of limitations, and to provide paper copies of this declaration, said returns, withholding statements, schedules,

and attachments upon request by the Colorado Department of Revenue at any time during this period.

ERO's Signature

Your social security Number

or Preparer Identification Number

check if also preparer

date

Form Dr 8453p - Partnership/s-Corp Income Tax Declaration For Electronic Filing When Feasible Attach In Pdf Format To Your E-Filed Return

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