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                                               DR 0350 (10/20/22)
                                               COLORADO DEPARTMENT OF REVENUE
                                               Tax.Colorado.gov
*DO=NOT=SEND*

    Instructions for First-time Home Buyer Savings Account 
                                               Interest Deduction

You must complete this form annually and file it with your       c.  Expenses that would have qualified under 
income tax return if you open and designate an account                   paragraphs 1 or 2 above, but the contract for 
as a first-time home buyer account. Please carefully read                purchase did not close;
all of the instructions, fully fill out the form, and submit     d.  As a transfer to another newly created first-
it with your income tax return with all of the requested                 time home buyer savings account; or
documentation for each first-time home buyer account 
you designate. Keep all of your account statements for           e.  To pay a service fee that is deducted by the 
the first-time home buyer account.                                       financial institution.
If you are claiming a first-time home buyer savings account      2.  I have not and will not claim any deduction for 
interest deduction, check the applicable box at the top of       interest or other income earned on contributions 
form DR 0350. You must submit account statements AND a           to my first-time home buyer savings account 
1099 showing only the taxable interest and/or earnings           exceeding $14,000 ($28,000 for account holders 
on the account in the tax year claimed. Upon withdrawal,         who file a joint return) for a taxable year or 
you must also submit a real estate settlement statement that     $50,000 for all taxable years.
shows that the withdrawal was used for an eligible expense.      3.  The amount in my first-time home buyer savings 
Eligible expenses are down payments or closing costs that        account will not exceed $150,000.
are included on the settlement statement (including, but not 
                                                                 4.  Money withdrawn from a first-time home buyer 
limited to, appraisal fees, mortgage origination fees, and 
                                                                 savings account is subject to recapture and/or 
inspection fees.)
                                                                 penalty in the taxable year in which it is withdrawn 
If claiming a deduction for multiple accounts, this form         as explained in section 39-22-4705(2), (3), and 
must be completed for each account.  The total amount            (4), C.R.S., if
of subtraction claimed from all first-time home buyer 
                                                                 a.  At the time of the withdrawal, it has been less 
savings accounts for this tax year should be transferred 
                                                                         than a year since the first deposit in the first-
to form DR 0104AD, line 19.
                                                                         time home buyer savings account;
To support my claim for the first-time home buyer savings 
                                                                 b.  The money is used for any purpose other than 
account interest deduction, I attest:
                                                                         those listed above;   or
1.  The money in my first-time home buyer 
savings account 1will only be used for the                       c.  The account holder(s) die.
following purposes, as provided by section 39-
                                                             1
22-4705, C.R.S.:                                                A “first-time home buyer savings account” is an account with a financial 
                                                               institution designated as such in accordance with section 39-22-
a.  Eligible expenses  related2 to a qualified                 4704(1) § 39-22-4703(6), C.R.S.
    beneficiary’s 3purchase of his or her primary            2 “Eligible expenses” are a down payment and any closing costs included 
    residence in Colorado                                      on a real estate settlement statement, including, but not limited to, 
                                                               appraisal fees, mortgage origination fees, and inspection fees. § 39-22-
b.  Eligible expenses related to a qualified                   4703(3), C.R.S.
    beneficiary’s purchase of his or her primary             3 A “qualified beneficiary” is a first-time home buyer designated by an 
    residence in or outside the state, if the                  account holder for whom the money in a first-time home buyer savings 
    qualified beneficiary is active-duty military and          account is or will be used for eligible expenses for the purchase of his or 
    was stationed in Colorado for any time after               her primary residence in the state. § 39-22-4703(7), C.R.S.
    the creation of the account;



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*220350==19999*

DR 0350 (10/20/22)
COLORADO DEPARTMENT OF REVENUE
Tax.Colorado.gov
Page 1 of 1

     2022 First-time Home Buyer Savings Account Interest Deduction
You MUST include this schedule with your paper return if you are claiming this deduction.

           I am claiming a Colorado subtraction for interest and/or earnings income in this tax year.

     I attest to the following:
           I am only claiming the interest earned from the account listed on this form.

           I received interest from the account listed on this form and I have included the amount in my Federal Taxable 
           Income on my federal return.

           I am NOT claiming mortgage interest (reported on a 1098) for a house I currently own.

           Any withdrawal taken from this first-time home buyer account was for an eligible expense (see instructions above.)

By claiming this deduction, I declare that to the best of my knowledge and belief, this affidavit is true, correct, and complete.
                                         Taxpayer Information
Account Holder Last Name                 First Name                                    Middle Initial SSN or ITIN

Account Holder Street Address

City                                                                  State ZIP                       Tax Year

                                         Account Information
Last Name of Beneficiary                 First Name of Beneficiary                     Middle Initial SSN or ITIN

Name of Bank or Institution                         Account number of the first-time home buyer account

Beginning of year balance in account   End of year balance in account Amount of interest deduction claimed for this tax year

$                                      $                              $






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