Form Dr 158-I-Web - Extension Payment Voucher For Colorado Individual Income Tax - 2006

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DR 158-I

WEB

COLORADO DEPARTMENT OF REVENUE

See Form Below

DETACH FORM

ON THIS LINE

MAKE A COPY FOR YOUR RECORDS

MAIL COMPLETED FORM WITH PAYMENT TO THE COLORADO DEPARTMENT OF REVENUE

DR 158-I

(19)

2006 Extension Payment Voucher for Colorado

COLORADO DEPARTMENT

Individual Income Tax

OF REVENUE

(calendar year– Due April 16, 2007)

Denver, CO 80261-0008

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.

IMPORTANT: ENTER YOUR SOCIAL SECURITY NUMBER

Your Last Name

First Name and Initial

Spouse's Last Name (if joint)

Spouse's First Name and Initial

Spouse's Social Security Number

Address

City, State, ZIP Code

IF NO PAYMENT IS DUE, DO NOT FILE THIS FORM

.00

(08)