DR 0349 (10/24/22) 
                                                       COLORADO DEPARTMENT OF REVENUE 
                                                       Tax.Colorado.gov
*220349==19999*                                        Page 1 of 1

      2022 Remediation of Contaminated Land Credit Use 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
                                                                                                                      2022
Pass-Through Entity Name              Ownership %                                    Entity FEIN

Use Of Credit  Complete this part if you are using or carrying forward credit on this tax return. 
 1.  What type of taxpayer        a.               b.                     c.               d.                e. Totals
      are you for each credit?        a transferee     a transferee           a transferee      a transferee (Attach additional 
                                                                                                             pages if necessary, 
                                                                                                             and only enter 
                                      a type of        a type of              a type of         a type of    overall totals on the 
                                      donor            donor                  donor             donor        final page.)
 2.  From whom did you 
      receive each credit?
 3.  Their Social Security 
      Number, ITIN or Federal 
      Identification Number
            OR
 4.  Their Colorado Account 
      Number
 5.  Tax Credit Certificate 
      Number
 6.  Date you received the 
      credit
 7.  Total credit available 
      for you to use. (Enter 
      the total credit less the 
      amount transferred, OR 
      the amount received 
      through transfers).          $                $                      $                $
 8.  Credit you used in prior 
      years                        $                $                      $                $
   9.  Credit available for you 
      to use this year, Line 7 
      minus Line 8. (Enter the 
      Total on form DR 0104CR 
      Line 33A, form DR 0105 
      Schedule G Line 5A, form 
      DR 0106CR Line 12A 
      or form DR 0112CR line 
      15A, if applicable.)          $                $                      $                $               $
 10.  Credit you are using this 
      year. (Enter the Total on 
      form DR 0104CR Line 33B, 
      form DR 0105 Schedule G 
      Line 5B, form DR 0106CR 
      Line 12B and/or 12C, or 
      form DR 112CR Line 15B.)     $                $                      $                $                $
   11.  Credit carried forward to 
      next year, subtract line 10 
      from line 9                   $                $                      $                $               $
I certify that I meet the requirements of  39-22-526, C.R.S.
Signature                                                                                                    Date (MM/DD/YY)

                                                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.