Form Dr 0461 - Quarterly Return Of Oil And Gas And Oil Shale Tax Withheld
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1Departmental Use Only
DR 0461 (05/16/06)
COLORADO DEPARTMENT OF REVENUE
1375 SHERMAN STREET
DENVER CO 80261-0007
(303) 238-SERV (7378)
QUARTERLY RETURN OF OIL AND GAS
AND OIL SHALE TAX WITHHELD
RETURN THIS COPY
Photocopy and keep copy for your own records.
Show below change of ownership, name and/or address
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
If this is your final return give closing date ______________________________________________________________________________
and reason _______________________________________________________________________________________________________
A
USE ACCOUNT NUMBER
LIABILITY INFORMATION
PERIOD COVERED
DUE DATE
C
for all references
Make checks or
county
city
indust.
type
liability date
month
month
year
month
day
year
T
money orders
payable to:
COLORADO
Social Security Number
Social Security Number
FEIN
DEPARTMENT
OF REVENUE
INSTRUCTIONS
LINE 1: Enter the total of all Colorado oil and gas severance taxes withheld from disbursements made during the quarter in Column A, and all
oil shale severance taxes withheld from disbursements made during the quarter in Column B.
LINE 2: Enter the total of any under payment adjustments for prior periods. Explain on reverse side.
LINE 3: Enter the total of any overpayment (not to exceed the sum of Lines 1 and 2) adjustments for prior tax periods. Explain on reverse side.
LINE 4: Penalty: 30% of tax or $30.00, whichever is greater if return is delinquent.
LINE 5: Interest applies at the current rate on the total tax due from the date due until paid if the return is delinquent.
LINE 6: Enter the total. (Add lines 1, 2, 4 and 5 minus Line 3.)
If Federal Employers Identification Number (FEIN) is pre-printed in the above space,
please check your records to see if you have the same number. If you have a
different number, correct the one above so that it corresponds with your records.
B.
A.
If no number appears in the above space, please fill in with the FEIN you have on your
OIL and GAS
OIL SHALE
records.
(4000-100)
$
.00 $
.00
1. Total Colorado Severance Tax Withheld ___________________________________
(100)
.00
.00
2. Additional Tax Due for Prior Period _______________________________________
(900)
$
.00 $
.00
3. Overpayment of Tax for Prior Period to be applied to Current Tax _______________
(905)
.00
.00
4. Penalty
% _____________________________________________
(200)
.00
.00
5. Interest (
% Per Month) ____________________________________
(300)
$
.00 $
.00
6. Total Amount Due and Payable __________________________________________
(355)
PLEASE INCLUDE THE ACCOUNT NUMBER ON YOUR CHECK TO ENSURE PROPER CREDIT
If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your
banking account electronically.
I hereby certify under penalty of perjury in the second degree that this return, including any accompanying schedules and statements,
is a true, correct and complete return to the best of my knowledge.
Trade Name
Date
Telephone
Signature of Officer or Agent
Title
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