Form Dr 0022x - Colorado Amended Colorado Molybdenum Ore Severance Tax Return

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For Department Use Only

DR 0022X (10/17/11)

Colorado department of revenue

Denver CO 80261-0007

(7104)

amended Colorado molybdenum

ore Severance tax return

Taxable Quarter

Year

round all amounts to the nearest dollar

20______

Jan–Mar

Apr–Jun

Jul–Sep

Oct–Dec

Name

Colorado Account Number

Address

Federal Employer ID Number

City

State

ZIP Code

Telephone Number

(

)

Check if final return

Mine Name as it is filed with CO Division of Mines

Number of Tons of Ore Mined

County or Counties in Which mine is located

1. Total tons mined ......................................................................................................................... 1

625,000

2. Exemption .................................................................................................................................. 2

-625,000

3. Total taxable tons mined (line 1 minus line 2) ............................................................................ 3

•

-31,250

4. Tax (line 3 x .05) .........................................................................................................

•

5. Impact assistance credit ..............................................................................................

6. Net tax, line 4 less Line 5, but not less than zero ...................................................................... 6

Stop here to let the department calculate your refund or balance due. Otherwise, manually complete the return yourself

and continue with line 7.

•

7. Enter the net tax from your original return or as previously adjusted .....................................

Compute tHe amount You oWe

•

8. Additional tax due, line 6 minus line 7, but not less than zero ................................................

•

9. Interest on additional tax .........................................................................................................

•

10. Penalty on additional tax .........................................................................................................

•

11. Total amount due, add lines 8, 9 and 10 ............................................................

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.

Compute Your refund

•

12. Refund claimed with this return, line 7 minus Line 6, but not less than zero .................................

Type:

Checking

Savings

Routing number

Account number

Reason for Amendment:

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

Name, address and telephone number of person

to the best of my knowledge and belief it is true, correct, and complete