Departmental Use Only
DR 0200 (07/11/16)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0013
(303) 238-SERV (7378)
Colorado Special District Sales
Tax Return Supplement
*160200==19999*
Mark here if this is an Amended Return
Acct. Number
Location/Juris Code
Due Date
Period
(MM/DD/YY)
(MM/YY-MM/YY)
0560-103
-
SSN
FEIN
Phone
(
)
Address
City
State
Zip
Name
Date
(MM/DD/YY)
Signature
Signed under penalty of perjury
in the second degree
(1-1)
(1-2)
— — —
— — —
•
00
00
00
00
1. Net taxable sales
Tax Rate
.0100 BRRTA
— — —
— — —
.0010 Football
— — —
— — —
00
00
00
00
2. Amount of sales tax
(3-1)
(3-2)
— — —
— — —
00
00
00
00
3. Excess tax collected
— — —
— — —
00
00
00
00
4. Total (add lines 2 & 3)
— — —
— — —
5. a. Service fee rate
(5-1)
(5-2)
— — —
— — —
00
00
00
00
b. Service fee allowed vendor
— — —
— — —
00
00
00
00
6. Sales Tax Due (line 4 minus line 5b)
(7-1)
(7-2)
— — —
— — —
00
00
00
00
7. Penalty
(8-1)
(8-2)
— — —
— — —
00
00
00
00
8. Interest
— — —
— — —
00
00
00
00
9. Total each tax (add lines 6, 7 & 8)
10. Total Amount Owed (Add all columns on line 9. Pay this amount with your return)
(355)
Paid by EFT
$
.0 0
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.