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(10/10/19)
               Booklet Includes:
                     DR 0021
                     DR 0021D
                                                                        Book
                     DR 0021S
                                                       21

                                   Colorado Severance Tax Booklet

               Colorado Severance Tax Forms

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

                                   DR 0021D 
                                   Oil and Gas Severance Tax 
                                   Computation Schedule

          2019                     DR 0021S 
                                   Application for Extension of Time to 
                                   File Colorado Severance Tax Return

          MAIL COLORADO SEVERANCE TAX RETURNS AND TAX 
          PAYMENTS TO

                     COLORADO DEPARTMENT OF REVENUE
                     Denver, CO 80261-0006



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                                                                 severance tax of 87.5% of your share of ad valorem taxes 
General Information                                              paid or assessed on actual oil or gas production (not the 
Colorado severance tax is imposed upon nonrenewable              tax on facilities or equipment). However,     ad valorem 
natural  resources  that  are  removed  from  the  earth  in     taxes on production from “stripper wells” should not 
Colorado. The tax is calculated on the gross income from oil     be  included  in  the  credit.  Specific  instructions  for  this 
and gas and carbon dioxide production.                           deduction are on the DR 0021D, Colorado Oil and Gas and 
Who Must File Return DR 0021                                     Carbon Dioxide Severance Tax Schedule. You should verify 
Anyone  who  receives  taxable  income  from  oil  or  gas  that the withholding statements accurately report the same 
produced in Colorado. If you are a producer or own a working  information as shown on your division of interest statements 
interest, or a royalty interest in any oil or gas (including carbon  and revenue checks.
dioxide) produced in Colorado, or if you receive royalties on 
                                                                 Important - Partners of a General Partnership
Colorado oil shale, you must pay severance tax to the State      Partners of a General Partnership should attach a copy 
of Colorado. Severance tax might be due even though you          of the partnership’s DR 0021W and a schedule detailing 
do not realize a net profit on your investment.                  their individual portion of gross income and taxes paid or 
A limited partnership, LLC or S Corporation must file at the     withheld as reported on their individual returns.
entity level. Partners, members, or shareholders do not file 
a severance tax return to report oil and gas income received     Filing Period
by the pass-through entity. A General Partnership will not       The Colorado severance tax filing period should match the 
file at the entity level. Each partner, and not the general      tax year/filing period used for federal income tax purposes.
partnership, is required to file a return.                       Filing Status
Oil and gas production from “stripper wells” is exempt from  The Colorado filing status will generally match the filing status 
severance tax. This includes oil from a well that produces  from your federal income tax return. However, the Colorado 
15 barrels or less of crude oil per day or gas from a well  severance tax filing status will always be joint if you are 
that produces 90,000 cubic feet or less of gas per day, for  married - regardless of whether you file jointly or separately. 
the average of all producing days during the taxable year.  Single or head of household filing statuses should file a single 
Each commodity must be tested for each well to determine  status Colorado severance tax return.
that commodity’s stripper well status. More information about 
                                                                 Due Date
stripper well withholding and filing requirements can be found   You  must  complete  and  file  the  DR  0021,  Colorado  Oil 
at Colorado.gov/Tax by reading FYI Withholding 4 and FYI         and Gas Severance Tax Return annually. The return (and 
General 4.                                                       payment, if any) are due by the 15th day of the fourth month 
                                                                 after the close of your taxable year. Therefore, if your taxable 
Exception                                                        year ends on December 31, your severance tax return is 
It is not necessary to file a severance tax return if you        due April 15 of the following year. The envelope must be 
meet both of the following conditions:                           postmarked by the due date, or the next business day if the 
   1. the total gross oil and gas withholding on form(s)         deadline falls on a Saturday, Sunday or holiday.
   DR 0021W for the calendar year is less than $250;             Mail Colorado severance tax returns and tax payments to:
   and                                                           Colorado Department of Revenue 
   2. the producer has withheld sufficiently from                Denver, CO 80261-0006
   royalty or production payments to cover the 
                                                                 Filing Extension
   severance tax liability.
                                                                 If you are unable to complete your severance tax return by 
                                                                 the due date and you estimate that you will owe severance 
Severance Withholding                                            tax,  you  can  request  a  six-month  extension  by  filing  the 
Producers or first purchasers who disburse funds must withhold 
                                                                 DR 0021S on page 7. If no balance of severance tax is due, 
1% of the gross income for   each interest owner. This can       an extension for filing is not required. 
include royalty, working interest or any other interest owner.
                                                                 The DR 0021S is an extension of time to file your return. It is 
The  producer  or  first  purchaser  is  required  to  send  the 
                                                                 not an extension of time to pay severance tax.
DR 0021W, Oil and Gas Withholding Statement to interest 
owners by March 1 of each year. This form lists the gross        A filing extension granted by the federal government will not 
income and the amount of severance tax the producer has          be honored for the Colorado severance tax return. Also, any 
withheld and paid to the state from your royalty or production   extension to file Colorado income tax returns does not apply 
payments. If you own an interest in more than one well or        to the Colorado severance tax return.
field, you should receive a separate withholding statement       Amended Returns
from  each  producer  or  first  purchaser. A copy of each       To change or correct a Colorado severance tax return, you 
withholding statement must be attached to your severance         must file a DR 0021X. This form is available for download 
tax return (DR 0021).                                            from Colorado.gov/Tax – the official Taxation web site.
The producer or first purchaser will also list your share of 
“ad valorem” taxes, if any, on the withholding statement. Ad     Returns For Prior Years
valorem taxes are paid by the producer to local governments      Colorado severance tax returns for prior years can be filed 
(cities  and  counties).  You  are  allowed  a  credit  against  at any time. However, the statute of limitations for claiming a 
                                                                 severance tax refund is three years from the due date.



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



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                                                                   withholding statements (DR 0021W) as Colorado severance 
DR 0021 Instructions                                               tax withheld. Add all amounts, then round to the nearest 
Who Must File                                                      dollar. Be sure to attach your DR 0021W forms to your 
Every individual, corporation, business trust, limited             return; missing DR 0021Ws will delay your refund. Do not 
partnership, LLC, partner in a general partnership,                claim credit for conservation tax or ad valorem taxes 
association, estate, trust or any other legal entity that          on this line.
received income from oil and gas produced in Colorado must         Line 5 Estimated Tax and Extension Payments
file a severance tax return. The return must be made for the       Enter on the total amount of your estimated tax and extension 
same tax year used for federal income tax purposes and is          payments made for the taxable year.
due on or before the 15th day of the fourth month following 
the end of the taxable year. See General Information section       Refund or Balance Due
for exception. If you are an oil and gas producer you must 
                                                                   Line 7 Overpayment
complete the DR 0021PD and retain for your records.                Subtract line 3 from line 6 and enter the difference on line 7. 
Controlled group: corporations, family group,                      The Department will send you a refund check for this amount 
                                                                   if your return is properly completed.
or other type of group
In the case of a controlled group of corporations as defined       Line 8 Refund
in section 613A of the Internal Revenue Code where more  Enter the amount from line 7 that you wish to have refunded. 
than one member of the group is subject to the severance  The Department can deposit your refund directly in to your 
tax, the tax must be jointly computed and the severance  account at a U.S. bank or other financial institution (such 
tax  return  must  be  jointly  filed  under  the  name  of  the  as a mutual fund, brokerage firm, or credit union) in the 
principal taxpaying corporation. DR 0021AS, available at  United States.
Colorado.gov/Tax must be attached.
                                                                   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 10. 
Social Security or Colorado Account Number                         This is the amount you owe. Attach to your return a check 
Individuals must use a Social Security number as the Colorado  or money order in this amount payable to the Colorado 
account number. Business entities must provide the Colorado  Department  of  Revenue.    Be  sure  to  write  your  Social 
account number (CAN) and the Federal Employer Identification       Security number or Colorado account number on your 
Number (FEIN). Whether you are an individual or a business         check or money order to ensure credit for your payment.
entity, once you have been assigned a Colorado account 
number by the Colorado Department of Revenue, use the              Line 11 Interest
Colorado account number on all returns and correspondence          If the return is filed after the due date, interest at the current 
submitted to the Department. See Colorado.gov/Tax for              statutory rate will accrue on any balance of tax due until 
Privacy Act Notice.                                                paid. The interest rate is 9% per year if we bill you and your 
                                                                   payment is made more than 30 days after you receive your 
Tax and Credit                                                     bill. If you pay your tax with your return or within 30 days of 
First, complete schedule DR  0021D to  calculate  your             receiving a bill, the interest rate is 6% per year. Enter the 
severance tax.                                                     amount of late 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.
Line 4 Severance Tax Withheld
Enter  the  total  amount  shown  on  all  of  your  oil  and  gas 



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           Departmental Use Only
                                            DR 0021 (06/18/19) 
                                            COLORADO DEPARTMENT OF REVENUE 
                                            Denver CO 80261-0006 
                                            Colorado.gov/Tax
                                            (7001)

                                                                                    2019 Colorado
                                                       Severance Tax–Oil and Gas DR 0021
*190021==19999*
Tax Year Beginning (MM/DD/19)                                           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

Tax and Credit – Complete schedule DR 0021D first. Attach the DR 0021D to 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, attach form DR 0021W                                                     4               00
                                                                                               • 
5. Estimated tax and extension payments                                                           5                 00
                                                                                               •
6. Total prepayments, add 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 
                                                (06/18/19)       2019 Colorado
*190021==29999*
                                                Severance Tax–Oil and Gas DR 0021
 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, add 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.
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 (06/28/19) 
                                             COLORADO DEPARTMENT OF REVENUE                                     (7040)
                                             Denver CO 80261-0008 
*190021S=19999*                              Colorado.gov/Tax

                        2019 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 not  Be sure to round your payment to the nearest dollar. The 
paid by the original due date of the return, penalty and interest  amount on the check and the amount entered on the payment 
will be assessed. If 90% or more of the net tax liability is paid  form must be the same. This will help maintain accuracy in 
by the original due date of the return and the balance is paid  your tax account.
when the return is filed by the last day of the extension period, Submit the DR 0021S with payment to:
only interest will be assessed.
                                                                                 Colorado Department of Revenue 
Use the DR 0021S to make a payment that must be made by                          Denver, CO 80261-0008
the original due date of the return to meet the 90% requirement.

                                                   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 (06/28/19)
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/19)                                           Ending: (MM/YY)

Your Last 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 (06/17/19) 
                                                      COLORADO DEPARTMENT OF REVENUE 
                                                      Denver CO 80261-0006 
*190021D=19999*                                       Colorado.gov/Tax

                                                        Colorado Oil And Gas Severance Tax 
                                                             Schedule (Attach to the DR 0021)
For tax year beginning (MM/19)     Ending (MM/YY)        Page              Of
                                                                                        Please round to whole dollars.

Taxpayer’s Last 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 0021W                           Attributable       Income                             Attributable to Valorem
   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. If line 4 is larger enter 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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                                                                                                         Page 11

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



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                      Please read all instructions before completing the forms.
STATE OF COLORADO 
DEPARTMENT OF REVENUE 
Denver CO 80261-0005

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
                    Forms and information are available Monday through Friday, 8:00 a.m. to 4:30 p.m. 
                    You may find directions to each service center on our web site at Colorado.gov/Tax

Colorado Springs                          Denver                                      Grand Junction 
2447 N. Union Blvd.                       1375 Sherman Street                         222 S. 6th Street, Room 208
Pueblo                                                                                Fort Collins 
827 W. 4th Street, Suite A                                                            3030 S. College Avenue

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






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