*210104==19999*
DR 0104 (12/07/21)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 1 of 4
2021 Colorado Individual Income Tax Return
Full-Year
Part-Year or Nonresident (or resident, part-year,
non-resident combination) *Must include DR 0104PN
Mark if Abroad on due date –
see instructions
Your Last Name Your First Name Middle Initial
Date of Birth
(MM/DD/YYYY) SSN or ITIN Deceased
If checked and claiming a refund, you must include
the DR 0102 and death certicate with your return.
Enter the following information from your current
driver license or state identication card.
State of Issue Last 4 characters of ID number Date of Issuance
If Joint, Spouse’s Last Name Spouse’s First Name Middle Initial
Spouse’s Date of Birth
(MM/DD/YYYY) Spouse’s SSN or ITIN Deceased
If checked and claiming a refund, you must include
the DR 0102 and death certicate with your return.
Enter the following information from your spouses
current driver license or state identication card.
State of Issue Last 4 characters of ID number Date of Issuance
Mailing Address Phone Number
City State ZIP Code Foreign Country (if applicable)
To see if you or members of your household qualify for free or reduced-cost health coverage, check this box if:
You are a Colorado resident and at least one person in your household does not have health coverage
AND
You give permission for the Colorado Department of Revenue to share the information on Form
DR 0104EE with Connect for Health Colorado (the Colorado Health Benet Exchange) and the
Department of Health Care Policy & Financing.
Round To The Nearest Dollar
1. Enter Federal Taxable Income from your federal income tax form:
1040, 1040 SR, or 1040 SP line 15. 1
0 0
Include W-2s and 1099s with CO withholding.
Additions to Federal Taxable Income
2. State Addback, enter the state income tax deduction from your federal form 1040,
1040 SR, or 1040 SP schedule A, line 5a (see instructions)
2
0 0
3. Qualied Business Income Deduction Addback (see instructions)
3
0 0
(0013)
4. Other Additions, explain (see instructions) 4
0 0
Explain:
5. Subtotal, sum of lines 1 through 4 5
0 0
Colorado Subtractions
6. Subtractions from the DR 0104AD Schedule, line 20, you must submit the
DR 0104AD schedule with your return.
6
0 0
7. Colorado Taxable Income, subtract line 6 from line 5
7
0 0
Tax, Prepayments and Credits: see 104 Book for full-year tax table and part-year DR 0104PN Schedule
8. Colorado Tax from tax table or the DR 0104PN line 36, you must submit the
DR 0104PN with your return if applicable.
8
0 0
9. Alternative Minimum Tax from the DR 0104AMT line 8, you must submit the
DR 0104AMT with your return.
9
0 0
10. Recapture of prior year credits
10
0 0
11. Subtotal, sum of lines 8 through 10 11
0 0
12. Nonrefundable Credits from the DR 0104CR line 43, the sum of lines 12, 13, and 14
cannot exceed line 11, you must submit the DR 0104CR with your return.
12
0 0
13. Total Nonrefundable Enterprise Zone credits used – as calculated, or from the
DR 1366 line 84, the sum of lines 12, 13, and 14 cannot exceed line 11, you must
submit the DR 1366 with your return.
13
0 0
14. Strategic Capital Tax Credit from DR 1330, the sum of lines 12, 13, and 14 cannot
exceed line 11, you must submit the DR 1330 with your return.
14
0 0
15. Net Income Tax, sum of lines 12, 13, and 14. Subtract that sum from line 11. 15
0 0
16. Use Tax reported on the DR 0104US schedule line 7, you must submit the
DR 0104US with your return.
16
0 0
17. Net Colorado Tax, sum of lines 15 and 16 17
0 0
18. CO Income Tax Withheld from W-2s and 1099s, you must submit the W-2s and/or
1099s claiming Colorado withholding with your return.
18
0 0
19. Prior-year Estimated Tax Carryforward
19
0 0
20. Estimated Tax Payments, enter the sum of the quarterly payments remitted for
this tax year
20
0 0
21. Extension Payment remitted with the DR 0158-I
21
0 0
22. Other Prepayments:
DR 0104BEP DR 0108 DR 1079 22
0 0
23. Gross Conservation Easement Credit from the DR 1305G line 33, you must submit
the DR 1305G with your return.
23
0 0
24. Innovative Motor Vehicle Credit from the DR 0617, you must submit each DR 0617
with your return.
24
0 0
Name SSN or ITIN
DR 0104 (12/07/21)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 2 of 4
*210104==29999*
25. Refundable Credits from the DR 0104CR line 9, you must submit the DR 0104CR
with your return. 25
0 0
26. Subtotal, sum of lines 18 through 25 26
0 0
Modied AGI for TABOR
Lines 28 through 30 are only used to calculate your TABOR Credit, they do not affect your Colorado tax liability.
27. Federal Adjusted Gross Income from your federal income tax form: 1040 line 11,
1040 SR line 11, or 1040 SP line 11
27
0 0
28. Nontaxable Social Security Income
28
0 0
29. Nontaxable Lump-sum Distribution from pension and prot sharing plans.
29
0 0
30. Nontaxable interest income from state and local bonds
30
0 0
31. Sum of lines 27 through 30: Modied AGI for TABOR 31
0 0
Modied AGI Tiers for State Sales Tax Refund
If line 31 is:
$44,000
or less
$44,001 –
$88,000
$88,001 –
$139,000
$139,001 –
$193,000
$193,001 –
$246,000
$246,001 –
or more
Single Filers Enter $37 $49 $56 $68 $74 $117
Joint Filers Enter $74 $98 $112 $136 $148 $234
32. State Sales Tax Refund: For full-year Colorado residents, born before 2003, or
full-year Colorado residents who are under the age of eighteen but are required
to le a return. Use the amount on line 31 and reference the table above. See
instructions if you are ling an extension.
32
0 0
33. Sum of lines 26 and 32
33
0 0
34. Overpayment, if line 33 is greater than line 17 then subtract line 17 from line 33 34
0 0
35. Estimated Tax Credit Carryforward to 2022 rst quarter, if any.
35
0 0
If you have an overpayment on line 36 below and would like to donate all or a portion of your overpayment to a qualied
Colorado charity, include Form DR 0104CH to contribute.
36. Refund, subtract line 35 from line 34 (see instructions)
36
0 0
Direct
Deposit
Routing Number Type: Checking Savings CollegeInvest 529
Account Number
For questions regarding CollegeInvest direct deposit or to open an account, visit CollegeInvest.org or call 800-448-2424.
DR 0104 (12/07/21)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 3 of 4
*210104==39999*
Name SSN or ITIN
*210104==49999*
37. Net Tax Due, subtract line 33 from line 17 37
0 0
38. Delinquent Payment Penalty (see instructions)
38
0 0
39. Delinquent Payment Interest (see instructions)
39
0 0
40. Estimated Tax Penalty, you must submit the DR 0204 with your return.
(see instructions)
40
0 0
41. Amount You Owe, sum of lines 37 through 40
41
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 insufcient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank
account electronically.
Third Party Designee
Do you want to allow another person to discuss this
return and any related information with the Colorado
Department of Revenue? See the instructions.
No Yes. Complete the following:
Designee’s Name Phone Number
Sign Below Under penalties of perjury, I declare that to the best of my knowledge and belief, this return is true, correct and complete.
Your Signature Date
(MM/DD/YY)
Spouse’s Signature. If joint return, BOTH must sign. Date (MM/DD/YY)
Paid Preparers Name Paid Preparers Phone
Paid Preparer’s Address City State ZIP Code
Name SSN or ITIN
DR 0104 (12/07/21)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 4 of 4
If you are ling this return with a check or
payment, please mail the return to:
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0006
If you are ling this return without a check or
payment, please mail the return to:
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
These addresses and zip codes are exclusive to the Colorado Department of Revenue, so a street address is not required.
File and pay at: Colorado.gov/RevenueOnline