Form Dr 0251 - Rta Consumer Use Tax Return And Instructions (Page 2 of 4) in pdf

PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

MAIL TO: Colorado Department of Revenue, Denver, CO 80261-0013

Make Checks or Money Orders Payable To: Colorado Department of Revenue

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.

DETACH FORM

ON THIS LINE

Photo Copy For Your Records Return Only The Coupon Below

Detach Here

—

DR 0251 Web (01/13/10)

Purchaser/Business Name

SSN/FEIN

Account Number

Location

0395-100

Street Address

City

County

ZIP Code

Period Covered

State

If out-of-state taxpayer, give Colorado address (Street, City, County, ZIP Code)

Signed under penalty of Perjury in the second degree

___________________________________ ___________ _____________

Signature

Date

Telephone Number

1a. Purchase invoices covering the tangible property included in this return. Attach a separate sheet of paper if necessary.

Invoice Date

Name of Vendor

Address

Amount

1b. Total from attachments...........................................................

Check here if this is an amended return ..

2. Write in name of RTA District here: See schedules provided.

3. Taxable Amount (total purchases 1a plus 1b) ..............................................................................................

4. Tax Rate (Tax rates vary, see schedules provided) ......................................................................................

5. Amount of Tax Due (Line 2 times Line 1c) ...................................................................................................

6. Net Tax Due .................................................................................................................................................(100)

7. Penalty: (see instructions). ...........................................................................................................................(200)

8. Interest & Penalty/Interest (see instructions) ...............................................................................................(300)

.00

9. Enter Total Payment Remitted .........................................................................................Paid by EFT

(355)