Form Dr 0020a - Colorado Metallic Minerals Severance Tax Return

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Departmental Use Only

DR 0020A (10/25/11)

COlOradO deParTMenT Of revenue

Denver CO 80261-0007

Colorado Metallic Minerals

(7009)

severance Tax return

Taxable year beginning _____________, 20 ____ Ending _____________ , 20 ____

Name

Colorado Account Number

Address

Federal Employer ID Number

City

State

ZIP

Telephone Number

(

)

Name of facility as identified with the Colorado Department of Natural Resources

County or counties in which operation is located

•

If this is a final return, check this box.

ROUND TO THE NEAREST DOLLAR

•

1. Gross income from mining operation ....................................................................................................

$19,000,000 00

2. Specific exemption (see instructions) ...................................................................................................

•

3. Taxable income, line 1 minus line 2. If line 2 is larger, enter zero ........................................................

•

4. Tax on gross income 2.25% of amount on line 3 ..................................................................................

•

5. Ad valorem tax

Check accounting method (see instructions)

Cash basis ........................................................................

Accrual basis or

6. 50% of the tax on line 4 ........................................................................................................................

•

7. Ad valorem tax credit, the smaller of lines 5 or 6 ..................................................................................

•

8. Tax, line 4 minus line 7 .........................................................................................................................

•

9. Impact assistance credit .......................................................................................................................

10. Net tax, line 8 minus line 9 but not less than zero ..............................................................................

•

11. Estimated tax and extension payments .............................................................................................

12. If line 11 is larger than line 10, enter your overpayment .....................................................................

•

13. Enter amount from line 12 you want refunded ....................................................................................

Routing number

Savings

Type:

Checking

Account number

•

14. Enter amount from line 12, if any, you want credited to estimated tax for next year ...........................

15. If line 10 is larger than line 11, enter the balance of tax due ..............................................................

•

16. Interest on balance of tax due ............................................................................................................

•

17. Penalty on balance of tax due ............................................................................................................

•

18. Estimated tax penalty .........................................................................................................................

•

19. Total amount due. Add lines 15 through 18 ..............................................................

Paid by EFT

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 bank account

electronically.

Name, address and telephone number of

Under penalty of perjury in the second degree, I declare that I have examined this return and to the best of my

knowledge and belief it is true, correct, and complete.

person preparing return:

Signature of Taxpayer or Corporate Officer

Date

Signature of Spouse

Date

Colorado Department of Revenue

Mail TO and Make CheCks Payable TO:

Denver, CO 80261-0007