DR 0019 (02/16/22)
COLORADO DEPARTMENT OF REVENUE
Service Center Section
PO Box 17087
Denver CO 80217-0087
Tax.Colorado.gov

Instructions for the Colorado Alternate Identification Number for the 
                  Property Tax/ Rent/Heat Rebate (PTC rebate) program

General Information                                             How to submit your application: Bring this application 
                                                                and supporting documentation to a Colorado Department of 
The DR 0019 is used to apply for an alternate identification 
                                                                Revenue Taxpayer Service Center or mail it to:
number assigned by the Colorado Department of Revenue to 
apply for the Property Tax/ Rent/Heat Rebate (PTC rebate)       Colorado Department of Revenue
program. The alternate identification number may not be         Service Center Section
used to file any other form of application or tax return. Do    PO Box 17087
not complete the DR 0019 if you have an SSN or ITIN. If you     Denver, CO 80217-0087
have an SSN or ITIN, you must use that number to apply for 
the PTC Rebate.                                                 Please allow at least 4-6 weeks before calling or emailing to 
                                                                check the status of your application.
Legal Name: Enter your legal name as it appears on your 
birth certificate or other legal documents. Please include 
                                                                Examples of Supporting Documentation 
suffixes, if applicable, such as senior, junior, etc.
                                                                Minimum of two required
Other  Names  Used:  Please  provide  other  names  you 
have gone by in the past which may be included on any           Phone bill                           Insurance policy
documentation you will provide.
                                                                Utility bill 
Physical  Address:  Enter  the  street  address,  city,  state,                                      Pay stub
                                                                (with service address)
and zip code  where  you currently reside. This must  be 
the address of a physical residence. P.O. Boxes are not 
                                                                Credit card statement        Vehicle registration/title
accepted. Documentation submitted with the application 
must show that you were present in Colorado for the 
                                                                                                     Rent receipt 
entire  calendar  year;  multiple  documents  may  need         Bank statement
to  be  submitted  to  demonstrate  presence  for  the                                               (not handwritten)
entire calendar year.                                           Lease agreement/
                                                                                                     Passport
                                                                mortgage statement
How long have you lived at this address?: Please indicate 
the number of years and months that you have resided at 
your current physical address.                                  Birth Certificate                    Military ID

Do you own or rent?: Please indicate whether you own or         Documents must show your name and current Colorado 
rent your current residence. Add your landlord’s name and       residential (not P.O. Box) address - including street 
contact info, if applicable.                                    address, city, and state. Documents must be dated within 
                                                                1 year. Electronic documents are accepted for proof of 
Mailing  Address: Enter the street address, city, state, 
                                                                residential address. 
and zip code where you currently receive mail through the                            Physical documents submitted 
United States Postal Service (USPS). All Departmental           with the DR 0019 application will not be returned.  
                                                                Photocopied documents are encouraged, do not send 
correspondence will be mailed to the mailing address 
                                                                original copies of documents.
provided in this section. 

Date of Birth: Enter your date of birth including a four digit 
year (Example - 12/31/1999).

DR 0019 (02/16/22)
COLORADO DEPARTMENT OF REVENUE
Service Center Section
PO Box 17087
Denver CO 80217-0087
Tax.Colorado.gov
Page 1 of 1                          Application for Alternate Identification Number
                    IMPORTANT - Do not forget to attach all required documentation with this application.

I,                                                           declare under penalty of perjury under the laws of the State of Colorado that:

    1.  I do not currently have a Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) issued 
        by the Social Security Administration (SSA) or the Internal Revenue Service (IRS).
    2.  I am a resident of the state of Colorado.
First Name                                                   Middle Name                                   Last Name

Suffix              Date of Birth (MM/DD/YYYY)               Marital Status      Other Names Used

    Other Government ID Number                               Type of ID                                    Issuing Agency or Country

Physical Address
Street Address                                                                                                                      Apartment Number

    City                                                                                                                      State ZIP Code

Email Address                                                                                                                 Telephone Number

How long have you resided at                                           Do you own or rent? Add landlord’s 
this address? (Years/Months)                                           name and contact info, if applicable
Mailing Address
Street Address                                                                                                                      Apartment Number

    City                                                                                                                      State ZIP Code

How long has this been your mailing address?
DID YOU ATTACH YOUR DOCUMENTATION? A minimum of two separate documents required. 
See instructions for examples of acceptable supporting documentation.

               Proof of Name                        Proof of Address             Copy of Birth Certificate Copy of Passport 

I declare, under penalty of perjury, that the statements herein are true and correct, as to every material matter, to the best of my knowledge and belief. 
I understand that this declaration is required by law because I have applied for an Alternate Identification Number.  I understand that state law requires 
me to provide proof that I am a resident of the State of Colorado prior to applying for the Property Tax/ Rent/Heat Rebate (PTC rebate) program. I further 
acknowledge that knowingly making a false statement or representation in this declaration is punishable under the criminal laws of Colorado under section 
39-21-118(4), C.R.S., and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
Your Signature                                                                                                                      Date

                                                             For Colorado Department of Revenue Use Only
    Alternate ID Assigned                       CAN Assigned Rejection Reason