DR 1299 (08/06/13)
*131299==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
Colorado Gross Conservation Easement
Holders Submission Of Information
Organization Name
Colorado Account Number
Tax Year
(YYYY)
A.
Number of conservation easements held by the organization in Colorado.
B. List the acreage for each conservation easement held in Colorado. Do not include any properties for which the
sole conservation purpose is historic preservation. Attach a schedule if additional space is needed.
Number of
Number of
Conservation Easement
Conservation Easement
Acres
Acres
1.
5.
2.
6.
3.
7.
4.
8.
Total acreage of conservation easements held by this organization
C. If the organization is a private nonprofit organization, list the names of the board members. If the organization is a
public entity, list the names of the elected or appointed officials. Attach a schedule if additional space is needed.
D. Date on which the organization received certification from the Division of Real
Date
(MM/DD/YY)
Estate pursuant to Section 12-61-720, C.R.S.
I declare that this organization has a commitment to protect the conservation purpose of each conservation easement donation
and has the resources to enforce the restrictions. Also, I declare that this organization has adequate resources and policies
in place to provide annual monitoring of each conservation easement held by the organization in Colorado, except for any
conservation easement granted to a local government that did not involve a charitable donation.
Authorized Signature
Date
(MM/DD/YY)
Title
Phone Number
Every charitable organization or governmental agency that accepts a conservation easement in gross in Colorado during the
year must file this form no later than April 15 of the following year. However, the report must be filed prior to accepting any new
conservation easement donation during the calendar year. Report all conservation easements held in Colorado on this form, not
just those donations received during the prior year. Copies of the completed form are available to the public from the Department of
Revenue or Division of Real Estate.
Mail signed copies of the completed form to both of the following State Departments:
Colorado Department of Revenue, Denver CO 80261-0005
Contact: or (303) 238-7378
Colorado Division of Real Estate, 1560 Broadway, Suite 925, Denver CO 80202
Contact: or (303) 894-2166