Form 104 - Colorado Individual Income Tax Return - 2010 Page 2
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25 Enter the amount from federal Form 1040, line 37; or from federal Form 1040A, line 21; or from
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federal Form 1040EZ, line 4 (Federal Adjusted Gross Income) .............................................. 25
.00
26 If line 24 is more than line 20, subtract line 20 from line 24. This is your overpayment ............ 26
.00
27 Amount you want credited to your 2011 estimated tax ........................................................ 27
ENTER THE AMOUNT, IF ANY, YOU WISH TO CONTRIBUTE TO:
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28 The Nongame and Endangered Wildlife Cash Fund ............................................................... 28
.00
29 The Colorado Domestic Abuse Program Fund ........................................................................ 29
.00
30 The Homeless Prevention Activities Program Fund ................................................................ 30
.00
31 The Special Olympics Colorado Fund ..................................................................................... 31
.00
32 The Western Slope Military Veterans’ Cemetery Fund ............................................................ 32
.00
33 The Pet Overpopulation Fund ................................................................................................ 33
.00
34 The Colorado Healthy Rivers Fund ......................................................................................... 34
.00
35 The Alzheimer’s Association Fund .......................................................................................... 35
.00
36 The Military Family Relief Fund ............................................................................................... 36
.00
37 The Colorado Breast and Women’s Reproductive Cancers Fund ........................................... 37
.00
38 The Adult Stem Cell Cure Fund ............................................................................................... 38
.00
39 The 9Health Fair Fund ............................................................................................................. 39
.00
40 The Make-A-Wish Foundation of Colorado Fund .................................................................... 40
.00
41 The Colorado 2-1-1 First Call for Help Fund ........................................................................... 41
.00
42 The Unwanted Horse Fund ..................................................................................................... 42
.00
43 Total of lines 27 through 42 ....................................................................................................... 43
.00
44 Line 26 minus line 43. This is your REFUND. e-file this return. Get your refund faster! ........ 44
(See page 9)
Type:
Savings
Checking
Routing number
Account number
AMOUNT YOU OWE
45 Penalty, also include on line 48 if applicable ........................................................................... 45
.00
46 Interest, also include on line 48 if applicable ........................................................................... 46
.00
47 Estimated tax penalty, also include on line 48 if applicable ..................................................... 47
.00
48 If line 20 is more than line 24, subtract line 24 from line 20. This is the amount you owe.
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Include amount entered on line 43 .......................................................................................... 48
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Pay online at , or make check payable to Colorado Department of Revenue.
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To ensure you receive credit for your payment by check, write your social security number and “2010 Form 104” on your check.
•
DO NOT send cash; DO NOT staple check to return.
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.
Do you want to allow another person to discuss this return with the Colorado Department of Revenue (see page 9)?
Yes. Complete the following.
No
Designee’s Name
Phone Number
Personal Identification Number (PIN)
Under penalties of perjury, I declare that to the best of my knowledge and belief, this return is true, correct, and complete.
Your Signature
Spouse’s Signature. If joint return, BOTH must sign.
Date
Year of Birth
Date
Year of Birth
MAIL YOUR RETURN TO:
Paid Preparer’s Name, Address and Telephone Number
COLORADO DEPARTMENT OF REVENUE
DENVER, CO 80261-0005
(10/07/10)
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