Form Dr 0100a - Retail Sales Tax Return For Occasional Sales (Page 2 of 2) in pdf

Form Dr 0100a - Retail Sales Tax Return For Occasional Sales Page 2

Departmental Use Only

DR 0100A (07/30/15)

COLORADO DEPARTMENT OF REVENUE

Denver, CO 80261-0013

Retail Sales Tax Return

for Occasional Sales

*140100A219999*

SSN#1

SSN#2

FEIN

Due Date

(MM/DD/YY)

0023-100

Last Name or Business Name

First Name

Middle initial

Address

Phone Number

(

)

City

State

Zip

Account Number

Period End Date (MM/YY)

Mark here if this is an Amended Return

1. Gross Sales

(1-4)

2. Total $ amount of merchandise purchased on which tax was paid at the time of purchase

(2-4)

3. Line 1 less line 2

(Enter this amount on line 6 in all applicable columns)

Colorado State

County Name

City Name

RTD

MHA

Tax

PSI

RTA

Other

4. Location of Sale

County Sales Tax Rate

City Sales Tax Rate

Special Dist Sales Tax Rate State Sales Tax Rate

5. Tax Rate

(indicate the appropriate tax

rate for the location on line 4)

.029

(4-1)

(4-2)

(4-3)

(4-4)

6. Net Taxable Sales for each Tax

(11-1)

(11-2)

(11-3)

(11-4)

7. Sales Tax Due

(tax rate x line 6)

(12-1)

(12-2)

(12-3)

(12-4)

8. Penalty

(see instructions)

(13-1)

(13-2)

(13-3)

(13-4)

9. Interest

(see instructions)

10. Total Each Tax

(add lines 7, 8, & 9)

11.

Amount Owed

The State may convert your check to a one time electronic banking transaction. Your bank account may 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 the payment amount directly from your

(355)

.00

bank account electronically.

I declare under penalty of perjury in the second degree, that the statements made herein are true to the best of my

knowledge and belief.

Signature

Date

(MM/DD/YY)

Mail to and make checks payable to: Colorado Department of Revenue

Denver, CO 80261-0013

Form Dr 0100a - Retail Sales Tax Return For Occasional Sales Page 2

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