Form Dr 0900 - Individual Income Tax Payment Voucher - 2012

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DR 0900 (07/21/12)
Web
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0008
Individual Income Tax Payment Voucher
CAUTION!
This form MUST accompany your payment if you filed electronically and wish to pay by check.
The Department strongly recommends that you file using
Complete the form below. The amount on the check and
Revenue Online or other electronic method and remit your
the amount entered on the payment voucher must be the
payment electronically or by EFT.
same. This will help maintain accuracy in your tax account.
Be sure to keep a copy of the money order or note the
However, to pay by mail, make check or money order
check number with your tax records.
payable to the Colorado Department of Revenue. Be sure
to round your payment to the nearest dollar. Clearly write
DO NOT submit a paper return if you have already filed
your Social Security number and “2012 Form 104” on the
electronically.
check memo line.
Use the coupon below only if you are unable to pay online or by EFT.
DETACH FORM
ON THIS LINE
Cut here and send only the coupon below. Help us save time and your tax dollars.
(0011)
2012 Individual Income Tax Payment Voucher
DR 0900 (07/20/12) Web
DR 0900 (07/20/12)
COLORADO DEPARTMENT OF REVENUE
(calendar year — Due April 15, 2013)
70
Denver CO 80261-0008
Return this voucher with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-0008. Write your Social Security
number and “2012 Form 104” on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this voucher.
First Name and Initial
Social Security Number
Your Last Name
Spouse Last Name (if joint)
Spouse First Name and Initial
Spouse Social Security Number
Address
City
ZIP
State
IF NO PAYMENT IS DUE, DO NOT FILE THIS FORM.
Amount of Payment
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.
(08)
$
. 0 0
(Do not write in space below)

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