Form 104 - Individual Income Tax - 2012
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1
2Departmental Use Only
FORM 104 (10/29/12)
Web
COLORADO
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Individual Income Tax
(0013)
Form 104
2012
Select Residency Status
Full-Year
Part-Year or Nonresident (or resident,
- or -
part-year, nonresident combination)
Fiscal Year Ending
Mark if Abroad on due date - see page 21
_________ ,20 ____
Last Name
First Name And Initial
Deceased
Date of Birth
Social Security Number
Primary
MM
DD
YYYY
Yes
Spouse, if joint
Yes
Mailing Address
Telephone Number
(
)
City
State
ZIP Code
Foreign Country (if applicable)
Round To The Next Dollar
1.
1
00
Enter Federal Taxable Income from your federal income tax form: 1040EZ line 6; 1040A line 27; 1040 line 43
Additions
2.
2
00
State Addback, enter the state income tax deduction from your federal form 1040 schedule A, line 5 (see instructions)
3.
3
00
Other Additions, explain (see instructions)
4.
4
00
Subtotal, add lines 1 through 3
Subtractions
State Income Tax Refund from federal income tax form: enter $0 if filing 1040EZ or 1040A; 1040 line 10
5.
5
00
6.
6
00
U.S. Government Interest
7.
7
00
Primary Taxpayer Pension/Annuity income
Deceased SSN:
8.
8
00
Spouse Pension/Annuity income
Deceased SSN:
9.
9
00
Colorado Source Capital Gain; 5-year assets acquired on or after 5/9/1994
10
Total Contribution $ __________________________
. Tuition Program Contribution: (see instructions)
Owner’s Name ____________________________
10
00
Owner’s SSN
_________________________
11
11
00
. Qualifying Charitable Contribution
Total Contributions $
. Qualified Reservation Income
12
12
00
13
13
00
. PERA/DPSRS Subtraction, for PERA contributions made in 1984–1986 or DPSRS contributions made in 1986
Railroad Benefit Subtraction, tier I or II only
14.
14
00
Wildfire Mitigation Measures Subtraction
15.
15
00
Other Subtractions, explain (see instructions) ____________________________________________
16.
16
00
17.
17
00
Subtotal, add lines 5 through 16
18.
18
00
Colorado Taxable Income, line 4 minus line 17
Tax, Prepayments and Credits: full-year residents turn to page 17 and part-year and nonresidents go to 104PN
19.
19
00
Colorado Tax from tax table or 104PN line 36
20.
20
00
Alternative Minimum Tax from Form 104AMT
21.
21
00
Recapture of prior year credits
22.
22
00
Subtotal, add lines 19 through 21
Staple
W-2s and
23.
23
00
Nonrefundable Credits from 104CR line 49, cannot exceed the sum of lines 19 and 20
1099s
24.
24
00
Net Tax, subtract line 23 from line 22
here.
Use only
25.
25
00
CO Income Tax Withheld from W-2s and 1099s. Staple only if line 25 is greater than $0.
for line
26.
Estimated Tax, enter the sum of payments and credits and amounts withheld from
25.
nonresident real estate sales and partnership/S corp/fiduciary income
26
00
27.
27
00
Refundable Credits from 104CR line 9
28.
28
00
Subtotal, add lines 25 through 27
29
. Federal Adjusted Gross Income from your federal income tax form: 1040EZ line 4;
29
00
1040A line 21; 1040 line 37
114,000
30.
30
00
Overpayment, if line 28 is greater than 24 then subtract line 24 from line 28
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