DR 0348 (06/30/21) 
                                                    COLORADO DEPARTMENT OF REVENUE 
                                                    Tax.Colorado.gov
*210348==19999*                                     Page 1 of 1

                           2021 Remediation of Contaminated Land 
                                 Credit Transfer Schedule
                  You MUST include this schedule with your return if you are claiming this credit.
Last Name or Business Name                                             First Name                              Middle Initial

SSN or ITIN                      Colorado Account Number               FEIN                           Tax Year Ending

Transferor’s Transfer Of Credit. Complete this part if you transferred credit for this tax year. 
Credit Amount Available (Total credit amount available from the Remediation of Contaminated      Credit Amount Available
Land Certificate DR 0349)
Detail of credit you transferred for this tax year. 
                                                                        Colorado Account     Date of   Amount of 
             Name of Transferee                      SSN or ITIN
                                                                       Number               Transfer        Credit

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

                                                                                                     $

Total Transferred                                                                                    $

Credit remaining (credit available, less total transferred).                                         $
                                 Submit additional pages as needed.
            For additional information regarding the credit, see FYI Income 42 available at Tax.Colorado.gov or
                                contact the Department of Revenue at 303-238-7378.