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(11/03/21)

                                       Booklet Includes:
                           DR 0021  |  DR 0021D  |  DR 0021S

          2021

                                       21

                   {       BOOK {
                   Colorado Severance Tax Booklet

                   Colorado Severance Tax Forms

              This book includes:
              y y  DR 0021 Oil and Gas Severance Tax Return

              y y  DR 0021D Oil and Gas Severance Tax Computation Schedule

              y y  DR 0021S Application for Extension of Time to File Colorado 
                   Severance Tax Return

              Tax.Colorado.gov

              Mail Colorado Severance Tax Returns and Tax Payments to

                   With                Colorado Department of Revenue
                   Payment             Denver, CO 80261-0006

              These addresses and zip codes are exclusive to the Colorado Department of Revenue, so a street address is not required.



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                                                                paid or assessed on actual, taxable oil and gas production 
General Information                                             (not the tax on facilities or equipment). Ad valorem taxes on 
Colorado  severance  tax  is  imposed  upon  nonrenewable       production from “stripper wells” should not be included 
natural resources that are removed from the earth in            in the credit. Specific instructions for this deduction are 
Colorado. The tax related to oil and gas is calculated on the   on the DR 0021D, Colorado Oil and Gas Severance Tax 
gross income from oil and gas and carbon dioxide production.    Schedule. You should verify that the withholding statements 
Who Must File Return DR 0021                                    accurately report the same information as shown on your 
Anyone  who  receives  taxable  income  from  oil  or  gas  division of interest statements and revenue checks.
produced in Colorado. If you own a working interest, or a 
                                                                Filing Period
royalty interest in any oil or gas (including carbon dioxide)   The Colorado severance tax filing period should match the 
produced in Colorado, or if you receive royalties on            tax year/filing period used for federal income tax purposes.
Colorado oil shale, you must pay severance tax to the State 
of Colorado. Severance tax might be due even though you         Filing Status
do not realize a net profit on your investment.                 The Colorado filing status will generally match the filing status 
A partnership, LLC or S Corporation must file at the entity     from your federal income tax return. However, the Colorado 
level.  Partners,  members,  or  shareholders  do  not  file  a severance tax filing status will always be joint if you are 
severance tax return to report oil and gas income received      married - regardless of whether you file jointly or separately 
by the pass-through entity.                                     for federal income tax purposes. If you are filing as single or 
                                                                head of household for income tax purposes, you should file 
Oil and gas production from “stripper wells” is exempt from     a single status Colorado severance tax return.
severance tax. This includes oil from a well that produces 
15 barrels or less of crude oil per day or gas from a well that Due Date
produces 90,000 cubic feet or less of gas per day, for the      You  must  complete  and  file  the  DR  0021,  Colorado  Oil 
average of all producing days during the taxable year. Each     and Gas Severance Tax Return, annually. The return (and 
commodity must be tested for each well to determine that        payment, if any) are due by the 15th day of the fourth month 
commodity’s stripper well status. More information about        after the close of your taxable year. Therefore, if your taxable 
stripper  well  withholding  and  filing  requirements  can  be year ends on December 31, your severance tax return is 
found by reading FYI Withholding 4 and FYI General 4 at         due April 15 of the following year. The envelope must be 
Tax.Colorado.gov - the official Taxation web site.              postmarked by the due date or the next business day if the 
                                                                deadline falls on a Saturday, Sunday or holiday.
Exception                                                       Mail Colorado severance tax returns and tax payments to:
It is not necessary to file a severance tax return if you       Colorado Department of Revenue 
meet both of the following conditions:                          Denver, CO 80261-0006
1. the total gross oil and gas withholding on form(s)           Filing Extension
DR 0021W for the calendar year is less than $250;               An automatic six-month extension of time for filing the 
and                                                             Colorado severance tax return is allowed for all taxpayers.
2. the producer has withheld sufficiently from                  However, an extension of time to file is not an extension 
royalty or production payments to cover the                     of time to pay the tax. If at least 90% of the net tax 
severance tax liability.                                        liability is not paid by the original due date of the return, 
                                                                penalty and interest will be assessed. If 90% or more of 
Severance Withholding                                           the net tax liability is paid by the original due date of the 
Producers or first purchasers who disburse funds must withhold  return and the balance is paid when the return is filed 
1% of the gross income for each interest owner. This applies  by the last day of the extension period, only interest will 
to any relevant interest owners, including those with royalty  be assessed.
interest or working interest.                                   Use  the  DR  0021S  to  make  a  payment  that  must  be 
The producer or first purchaser is required to send the DR  made by the original due date of the return to meet the 
0021W,  Oil  and  Gas  Withholding  Statement,  to  interest  90% requirement.
owners by March 1 of each year. This form lists the gross 
income and the amount of severance tax the producer has         Amended Returns
withheld and paid to the state from your royalty or production  To change or correct a Colorado severance tax return, you 
payments. If you own an interest in more than one well or       must file a DR 0021X. This form is available for download 
field, you should receive a separate withholding statement      from Tax.Colorado.gov.
from  each  producer  or  first  purchaser. A copy of each 
                                                                Returns For Prior Years
withholding statement must be included with your severance      Colorado severance tax returns for prior years can be filed 
tax return (DR 0021).                                           at any time. However, the statute of limitations for claiming 
The producer or first purchaser will also list your share of    a severance tax refund is three years from the due date. 
“ad valorem” taxes, if any, on the withholding statement. Ad    Colorado severance tax returns for prior years are available 
valorem taxes are paid by the producer to local governments     for download from Tax.Colorado.gov.
(cities  and  counties).  You  are  allowed  a  credit  against 
severance tax of 87.5% of your share of ad valorem taxes 



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Estimated Severance Tax Payments                                 Married couples must file jointly even if only one 
Corporations who expect their Colorado severance tax               spouse has oil and gas income or the couple uses a 
liability  for  the  year to exceed  their  Colorado severance     different filing status for income tax purposes.
credits by $5,000 or more are required to make estimated 
tax payments. Estimated tax payments are due each month          Taxpayers must complete the DR 0021D, Colorado 
by the 15th day of that month and    must be submitted by          Oil and Gas Severance Tax Schedule, and include it 
Electronic Funds Transfer (EFT). A paper form for these tax        with the DR 0021 return. Both of these forms are in 
payments is not required; the EFT transaction is the filing.       this booklet.
Visit Tax.Colorado.gov/electronic-funds-transfer for more        Be sure to carry the correct totals from the DR 0021D 
information on how to register and file through EFT.               schedule to the DR 0021 return.
Individuals are not required to make estimated payments for 
severance tax.                                                   Include all DR 0021Ws (Oil and Gas Withholding 
                                                                   Statement) with the DR 0021 return. Missing DR 
Deceased Persons                                                   0021Ws result in delayed refunds.
Legal  representatives  and  surviving  spouses  may  file  a 
return on behalf of a deceased person. Complete the return       Add up all the DR 0021W withholding statements, 
as usual. Write “Deceased” in large letters in the white space     then round to the nearest dollar. Do not round each 
above the tax year of the return, mark the deceased box for        individual DR 0021W statement and then add them.
the appropriate person, and fill in the date of death. Write     Do not use a 1099-MISC withholding document for 
“Filing as surviving spouse” or “Filing as legal representative”   severance tax filing. 1099s are income tax withholding 
after your signature, and include the DR 0102 (refunds only)       documents. They will not report severance tax 
and a copy of the death certificate.                               withholding and the department will not allow credit 
Record Retention                                                   based on the withholding shown on a 1099 document.
Keep all documentation you used to prepare your return           Do not claim a percentage of the withholding shown 
for at least three years after the due date or filing date of      on the DR 0021W and do not create spreadsheets to 
your return, whichever is later. If your return is audited by      show the ownership percentage. Use the amounts on 
the Colorado Department of Revenue, you must be able to            the DR 0021W. The ownership percentage has already 
provide back-up documents for all claims and credits listed on     been calculated by the entity that issued the DR 
your return. Please note that you are not protected from audit 
                                                                   0021W withholding statement.
adjustments to your severance tax return simply because 
an operator or purchaser supplied the information. Also, the     Do not claim all of the withholding but only part of 
Department of Revenue may request copies of your federal           the income.
and Colorado income tax return or other documentation in           Do not deduct gross payments attributable to stripper 
                                                                 
connection with your Colorado severance return.
                                                                   well production if these are not shown as stripper well 
Income Tax Filing Requirement                                      income on a DR 0021W.
Severance tax is different from income tax. If you receive oil, 
                                                                 Taxpayers are either on an accrual basis or a cash 
gas or CO 2income from Colorado sources you must also              basis not both. Most individuals are on a cash basis 
complete and file a Colorado state income tax return. Visit 
                                                                   while most corporations are on an accrual basis.
Tax.Colorado.gov  to download the DR 0104, which can be 
filed electronically for free using Revenue Online. See the DR   If a return is filed on behalf of an entity such as 
0104 for details. Do not claim severance tax withholding           partnership or limited liability company, do not try to file 
as a tax credit on your Colorado income tax return.                as an individual.
Failure To File                                                  Corporations that expect their Colorado severance 
If your severance tax account is open, or if you have              tax liability for a tax year to exceed their Colorado 
severance income that is reported to the Colorado                  severance tax credits by $5,000 or more are required 
Department of Revenue and you do not file a return for             to make estimated tax payments.
the tax period, the Department may file a return on your 
behalf.  This  does  not  apply  if  you meet  the  conditions   To avoid underestimation penalties, corporations must 
under the “Exception” section on page 2 of this booklet.           make severance tax estimated payments by the 15th day 
Any severance tax assessed if the Department does file             of the month and payments must be submitted by EFT.
on your behalf will remain due and payable until you file 
your return or close your account. If you are no longer          Please visit Tax.Colorado.gov for more information.
doing business in the State of Colorado, you are required to 
close your account by filing the DR 1102, Account Change 
or Closure Form.
Common Filing Errors 
Be alert to the following filing tips to avoid delays in return 
processing, payments and refunds.
  Indicate the correct tax year or fiscal year when filing a 
    Colorado severance tax return.



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DR 0021 Instructions                                             Line 4 Severance Tax Withheld
                                                                 Enter  the  total  amount  shown  on  all  of your  oil  and  gas 
Who Must File                                                    withholding statements (DR 0021W) as Colorado severance 
Every individual, corporation, business trust, limited           tax withheld. Add all amounts, then round to the nearest 
partnership, LLC, partner in a general partnership,              dollar. Be sure to include your DR 0021W forms with your 
association, estate, trust or any other legal entity that        return; missing DR 0021Ws will delay your refund. Do not 
received income from oil and gas produced in Colorado must       claim credit for conservation tax or ad valorem taxes 
file a severance tax return. The return must be made for the     on this line.
same tax year used for federal income tax purposes and is 
                                                                 Line 5 Estimated Tax and Extension Payments
due on or before the 15th day of the fourth month following      Enter the total amount of your estimated tax and extension 
the end of the taxable year. See General Information section     payments made for the taxable year.
for exception. If you are an oil and gas producer you must 
complete the DR 0021PD and retain for your records.              Refund or Balance Due
Controlled group: corporations, family group,                    Line 7 Overpayment
or other type of group                                           Subtract line 3 from line 6 and enter the difference on line 7. 
In  the  case  of  a  controlled  group  of  corporations  as    Line 8 Refund
defined in section 613A of the Internal Revenue Code             Enter the amount from line 7 that you wish to have refunded. 
where more than one member of the group is subject to            The Department can deposit your refund directly into your 
the severance tax, the tax must be jointly computed and          account at a U.S. bank or other financial institution (such as 
the severance tax return must be jointly filed under the         a mutual fund, brokerage firm, or credit union) in the United 
name of the principal taxpaying corporation. DR 0021AS,          States or the Department can send you a refund check.
available at Tax.Colorado.gov,  must be included.
                                                                 Line 9 Refund Applied to Future Period
Joint Returns                                                    Enter on line 9 the amount of overpayment, if any, you wish 
When more than one member of a family is subject to the          credited to estimated severance tax payment for next year.
severance tax, they shall compute the severance tax on one 
combined return. Note: parties to a Civil Union should refer to  Line 10 Tax You Owe
federal tax law to determine the correct filing status.          If line 3 is more than line 6, you have additional tax to pay. 
                                                                 Subtract line 6 from line 3 and enter the difference on line 
Social Security or Colorado Account Number                       10. This is the amount you owe. Include with your return a 
Individuals must use a Social Security number (SSN) or           check or money order in this amount payable to the Colorado 
Individual Taxpayer Identification number (ITIN) as the          Department  of  Revenue.   Be  sure  to  write  your  Social 
Colorado account number. Business entities must provide          Security number or Colorado account number on your 
the  Colorado  account  number  (CAN)  and  the  Federal         check or money order to ensure credit for your payment.
Employer Identification number (FEIN). Whether you are 
an individual or a business entity, once you have been           Line 11 Interest
assigned a Colorado account number by the Colorado  If the return is filed after the due date, interest at the current 
Department of Revenue, use the Colorado account number  statutory rate will accrue on any balance of tax due until paid. 
on  all returns and correspondence submitted to the  For the current interest rates, refer to publication FYI General 
Department. See Tax.Colorado.gov for Privacy Act Notice.         11. The regular rate will apply if we bill you and your payment 
                                                                 is made more than 30 days after you receive your bill. If you 
Tax and Credit                                                   pay your tax with your return or within 30 days of receiving a 
First, complete schedule DR  0021D to  calculate  your           bill, the discounted rate will apply. Enter the amount of late 
severance tax.                                                   filing interest on line 11.
Line 1 Oil and Gas Severance Tax                                 Line 12 Penalty
Enter your net tax from line 5 of schedule DR 0021D.             The penalty on any late filed return with a balance of tax due 
                                                                 is $30 or 30% of the balance of tax due, whichever is greater. 
Line 2 Impact Assistance Credit                                  Enter the amount of late filing penalty on line 12.
A credit against the severance tax is allowed with respect 
to contributions to local government that are deemed to be       Line 13 Estimated Tax Penalty
necessary because of a new severance operation or the  Corporations that underpay the estimated tax must enter the 
increase in production at an existing operation. The amount  penalty due from the DR 0206.
of the credit must be certified by the Executive Director of the 
Department of Local Affairs. Enter your impact assistance        Be sure to sign your return! If filing a joint return, both 
credit for the year on line 2.                                   parties must sign. 
                                                                 To ensure proper processing, please include your 
Line 3 Net Tax                                                   account number on the return.
Subtract line 2 from line 1, and enter the difference on line 3. 
If line 2 is larger than line 1, enter zero.



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                                                                 in the tax period whether you actually received the income 
Instructions For Preparing                                       or not, including deferred amounts if they are reported on 
Severance Tax Schedule DR 0021D                                  the federal income tax return.
Use the DR 0021D to calculate the amount of Colorado             Cash Basis Taxpayers
severance tax to enter on line 1 of the DR 0021.                 Report only ad valorem tax (on production) actually paid to 
Based on your accounting method (cash or accrual basis),  the county assessor during the severance tax year. Payments 
use the amounts listed on the DR 0021W you received to  to operators of wells do not qualify. If a payment is skipped 
complete DR 0021D. If you disagree with the information          during a tax year (for example, delinquent), no claim for tax is 
provided by a producer/first purchaser, you must request         allowed. Catch-up or double payments must all be claimed in 
a corrected DR 0021W prior to completing the DR 0021D.           the year paid and cannot be carried back or forward.
Round all amounts to whole dollars.                              Accrual Basis Taxpayers
Column                                                           Report  only  ad  valorem  tax  (on  production)  levied,  or 
(A)  Producer Name. Enter in column (A) the name of              assessed, within the severance tax year. In November or 
    the producer/first purchaser from each DR 0021W. All         December, depending upon the year, the Colorado counties 
    information entered on form DR 0021D must have a             set the mill levy for assessment of ad valorem tax on the prior 
    form DR 0021W included with the return.                      year’s oil and gas production. The ad valorem tax is not 
                                                                 accruable until the amount is established on that date.
(B) Gross Income. Enter in column (B) the gross 
    income as reported on DR 0021W. This is your                 Short Period Returns
    share of the gross income received or accrued on             Because severance tax requires filing periods consistent with 
    oil or gas production.                                       federal income tax filing years, some companies may have to 
                                                                 file short period severance tax returns to match their federal 
(C)  Gross Income Attributable To Stripper Well 
                                                                 filings. The same ad valorem rules apply. If no payment (cash 
    Production. Enter in column (C) the gross income 
                                                                 basis) or accrual date (accrual basis) falls within the short tax 
    attributable to stripper well production as reported on      period, no claim for ad valorem tax is allowed. If the levy or 
    the DR 0021W.                                                payment date does fall in the short period, all the tax applies 
(D)  Net Gross Income. Enter in column (D) the net               to only that short period.
    gross income by subtracting the stripper well gross 
    income listed in column (C) from the gross income            To expedite the processing of your severance tax return, 
    listed in column (B).                                        include all documentation to support ad valorem taxes, 
(E)  Ad Valorem Tax. Enter in column (E) the ad valorem          gross income and severance tax withheld.
    tax as reported on the DR 0021W. This is the amount          Mail your severance tax return and payment, if any, 
    paid or accrued to Colorado local governments in             separately from your Colorado income tax return or any 
    the taxable year on oil and gas production. Do not           other tax return. 
    include ad valorem tax on buildings, improvements, 
    or equipment. A percentage of ad valorem tax is 
    allowed as a reduction to the severance tax.
(F)  Ad Valorem Tax Attributable To Stripper Well 
    Production. Enter in column (F) the ad valorem tax 
    attributable to stripper well production as reported on 
    the DR 0021W.
(G)  Net Ad Valorem Tax. Enter in column (G) the net 
    ad valorem tax by subtracting the stripper well ad 
    valorem tax listed in column (F) from the ad valorem 
    tax listed in column (E).

**Note** Reporting revenue and ad valorem taxes in the 
correct tax year is critical to filing a correct return. Please 
review the following information.

Cash or Accrual Basis. Oil and gas revenue, along with 
related ad valorem tax, must be reported on a basis 
consistent with the basis used for filing your federal income 
tax return. Thus, if you are a cash basis federal taxpayer 
(this applies to most individuals), reporting income when 
received and deductions when paid, you must report the 
same way on the severance tax schedule (DR 0021D). 
You should include only the income received in the tax 
period. If you use the accrual basis (this applies to most 
corporations), you must report income from all production 



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                                                       DR 0021 (06/25/21) 
                                                       COLORADO DEPARTMENT OF REVENUE 
                                                       Denver CO 80261-0006 
*210021==19999*                                        Tax.Colorado.gov
                                                       Page 1 of 2
                                                       (7001)

                       2021 Colorado Severance Tax–Oil and Gas
Tax Year Beginning (MM/DD/21)                                            Ending (MM/DD/YY)

Last Name or Business Name                                                                First Name       Middle Initial

                              Date Deceased (MM/DD/YY)                   SSN or ITIN                   Colorado Account Number
 Deceased           Yes

 If Joint, Spouse or Partner Last Name (see controlled group definition)                  First Name       Middle Initial

                              Date Deceased (MM/DD/YY)                                    SSN or ITIN
 Deceased           Yes

Address                                                                                                FEIN

Foreign Country                             City                                          State  ZIP   Phone Number

If this is a final return, check this box   Are you a producer of Colorado Oil or Gas?                 Yes           No

Check one:             Cash Basis Filer                 Accrual Basis Filer

Tax and Credit – Complete schedule DR 0021D first. Include the DR 0021D with this                      Round To The 
                    form when you file                                                                 Nearest Dollar

 1. Oil and gas tax, enter amount from line 5, DR 0021D                                            1                 00
                                                                                                
 2. Impact assistance credit                                                                       2                 00
                                                                                                
 3. Net tax, line 1 minus line 2 but not less than zero                                           3                  00
                                                       Prepayments

 4. Severance tax withheld, include form(s) DR 0021W                                                 4               00
                                                                                                
 5. Estimated tax and extension payments                                                           5                 00
                                                                                                
 6. Total prepayments, sum of lines 4 and 5                                                          6               00
                                                        Refund

 7. If line 6 is larger than line 3, enter your overpayment                                          7               00

 8. Enter amount from line 7 you want refunded                                                       8               00
                                                                                                
 9. Enter amount from line 7, if any, you want credited to estimated tax for next year             9                 00
                                                                                                



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                                               DR 0021 (06/25/21) 
                                               COLORADO DEPARTMENT OF REVENUE 
                                               Denver CO 80261-0006 
*210021==29999*                                Tax.Colorado.gov
                                               Page 2 of 2

                       2021 Colorado Severance Tax–Oil and Gas

 Name                                                                                Account Number

                               Routing Number                             Type:  Checking       Savings
       Direct
       Deposit                 Account Number

                                                     Balance Due

 10. If line 3 is larger than line 6, enter the balance due here                 10                                00

 11. Interest on balance due                                                      11                               00
                                                                                
 12. Penalty on balance due                                                       12                               00
                                                                                
 13. Estimated tax penalty (corporations only)                                    13                               00
                                                                                
 14. Total amount due, sum of lines 10, 11, 12 and 13             Paid by EFT     14
                                                                                
The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as 
early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due 
to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank 
account electronically.
                       Mail Your Severance Tax Return Separately From Your Income Tax Return.
 Include Form DR 0021W Withholding Forms and Form DR 0021D Colorado Oil and Gas Severance Tax Schedule. 
Mail to and make checks payable to:  Colorado Department of Revenue
                                              Denver, CO 80261-0006
Under penalty of perjury in the second degree, I declare that I have examined this return and to the best of my 
knowledge and belief it is true, correct, and complete.
Signature of Individual Taxpayer                                                                Date (MM/DD/YY)

Spouse’s Signature                                                                              Date (MM/DD/YY)

Signature of Corporate Officer                                                                  Date (MM/DD/YY)

Preparer’s Last Name                           Preparer’s First Name                            Preparer’s Phone Number

Address

City                                                                                      State ZIP



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                                                  DR 0021S (06/17/21) 
                                                  COLORADO DEPARTMENT OF REVENUE                                (7040)
                                                  Denver CO 80261-0008
*210021S=19999*                                   Tax.Colorado.gov
                                                  Page 1 of 1

                        2021 Extension Of Time For Filing Colorado  
                                Oil And Gas Severance Tax Return
Colorado severance tax returns are due to be filed by the  If after the original due date of the return it is found that the 
fifteenth day of the fourth month after the close of the tax year. amount paid is insufficient to meet the 90% requirement, 
An  automatic  six-month  extension  of  time  for  filing  the  additional payment should be made as soon as possible 
Colorado severance tax return is allowed for all taxpayers.  to reduce accumulation of penalty and interest. Make such 
However, an extension of time to file is not an extension of  payment with the DR 0021S.
time to pay the tax. If at least 90% of the net tax liability is 
                                                                 Be sure to round your payment to the nearest dollar. The 
not paid by the original due date of the return, penalty and 
                                                                 amount on the check and the amount entered on the payment 
interest will be assessed. If 90% or more of the net tax 
liability is paid by the original due date of the return and the form must be the same. This will help maintain accuracy in 
balance is paid when the return is filed by the last day of the  your tax account.
extension period, only interest will be assessed.                Submit the DR 0021S with payment to:
Use the DR 0021S to make a payment that must be made by                         Colorado Department of Revenue 
the original due date of the return to meet the 90% requirement.                Denver, CO 80261-0008

                                                  Worksheet
 1.  Tentative amount of tax for the taxable year after reduction for the impact 
     assistance credit (if any)                                                                                                             $

 2.  Less: (a) Severance tax withheld                                                                                                       $

        (b) Estimated tax payments                                                                                                          $

        (c) Total (a) and (b)                                                                                                               $
 3.  Balance to be remitted with this request for extension, line 1 minus line 2 (c). 
     Enter amount of payment below. Claim credit for this payment on line 5 of the DR 0021                                                  $
                                If no payment is due, do not file the DR 0021S.
DR 0021S (06/17/21)
Return the DR 0021S with check or money order payable to the Colorado Department of Revenue, Denver, Colorado 80261-
0008. Write your Social Security number, ITIN, Colorado Account Number or Federal Employer Identification Number and 
DR 0021S on your check or money order. Do not send cash. Enclose, but do not staple or attach, your payment with this form.
For Tax Period: (MM/21)                                          Ending: (MM/YY)

Your Last Name or Business Name                         First Name                                              Middle Initial SSN or ITIN

Spouse’s Last Name                                      First Name                                              Middle Initial Spouse’s SSN or ITIN

Address                                                                                                                                     FEIN

City                                              State ZIP              Foreign Country

If no payment is due, do not file this form.                                                                                                    Amount Owed
The State may convert your check to a one-time electronic banking transaction. Your bank account may be debited as early as the 
same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected 
funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.                              $



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                                                      DR 0021D (06/17/21) 
                                                      COLORADO DEPARTMENT OF REVENUE 
                                                      Denver CO 80261-0006 
*210021D=19999*                                       Tax.Colorado.gov
                                                      Page 1 of 1

Colorado Oil and Gas Severance Tax Schedule (Include with the DR 0021)
For tax year beginning (MM/21)     Ending (MM/YY)        Page              Of
                                                                                       Please round to whole dollars.

Taxpayer’s Last Name or Business Name             First Name                       Middle Initial SSN, ITIN or Colorado Account Number

   (A)                         (B)                (C)            (D)               (E)            (F)           (G)
Producer Name  Gross Income Gross Income                     Net Gross       Ad Valorem           Ad Valorem    Net Ad
   List each                              Attributable           Income                  Attributable to        Valorem
DR 0021W on a                             to Stripper Well (Column B-C)                           Stripper Well (Column E-F)
Separate Line                             Production                                              Production

Check Accounting Method                Cash basis     or              Accrual basis

1. Net gross income [total of column (D)]                                                1                             00
                                                                                       
2. Tax on total net gross income (see tax rate schedule below)                           2                             00
                                                                                       
3. Net ad valorem tax [total of column (G)]                                              3                             00
                                                                                       
4. Ad valorem tax credit, 87.5% of the amount on line 3                                  4                             00
                                                                                       
5. Net tax on oil and gas income, line 2 minus line 4, but not less than 0. 
   Enter here and on line 1 of the DR 0021.                                              5                             00
                                                      Tax Rate Schedule
If total net gross income is:                         The tax is:
Under $25,000                                         2% of gross income
$25,000–$99,999                                       $500 plus 3% of the excess over $24,999
$100,000–$299,999                                     $2,750 plus 4% of the excess over $99,999
$300,000 and over                                     $10,750 plus 5% of the excess over $299,999



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                     Please read all instructions before completing the forms.
STATE OF COLORADO 
DEPARTMENT OF REVENUE

Official State of 
Colorado Publication

                                         Secure Messaging
Contact Department of Revenue support staff electronically through Revenue Online. This service is secure and 
                     confidential. Visit Colorado.gov/RevenueOnline to register and get started.

                                         Call Center
                                         Assistance 303-238-SERV (7378) 
                                         Monday–Friday 8:00 a.m.–4:30 p.m.

                                         Service Centers
All visits for assistance and information can be scheduled at our web page at Tax.Colorado.gov/Visit-a-Service-Center. 
Forms are available Monday through Friday, 8:00 am to 4:30 pm. For those who do not need assistance, each 
service center is equipped with a secure drop box for documents. 

Colorado Springs                         Denver Metro                         Grand Junction 
2447 N. Union Blvd.                      1881 Pierce Street, Entrance B       222 S. 6th Street, Room 208
Pueblo                                   Lakewood, CO                         Fort Collins 
827 W. 4th Street, Suite A                                                    3030 S. College Avenue

                     Visit Tax.Colorado.gov to find other severance tax 
                     forms and schedules not included in this booklet.






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