Form Dr 1083 - Information With Respect To A Conveyance Of A Colorado Real Property Interest - 2013

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DR 1083 (10/17/13)
*141083==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
www.
Information with Respect to a Conveyance
of a Colorado Real Property Interest
1.
First Name
Middle Initial
Transferor's Last Name
Address
City
State
Zip
Spouse's Last Name (if applicable)
First Name
Middle Initial
Address
City
State
Zip
2. Transferor is (check one):
If other, please specify:
Individual
Estate
Corporation
Trust
Other (specify)
3.
4.
Colorado Account Number
SSN
FEIN
5.
6.
Type of property sold
Date of closing
(MM/DD/YY)
7.
City
State
Zip
Address or legal description of property sold
8. Selling price of the property
$
9. Selling price of this transferor's interest
$
10. If Colorado tax was withheld, check this box
11. Amount of tax withheld
$
12. If withholding is not made, give reason (check one):
a. Affirmation of Colorado residency signed
b. Affirmation of permanent place of business signed
c. Affirmation of principal residence signed
d. Affirmation of partnership signed
e. Affirmation of no tax reasonably estimated to be due to no gain on sale signed
f. No net proceeds
13.
Phone Number
Title Insurance Company
(
)
Address
City
State
Zip
File this form together with DR 1079, if applicable, within 30 days of the closing date with the
Colorado Department of Revenue
Denver, CO 80261-0005

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