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                                              DR 0021X (06/26/19) 
                                              COLORADO DEPARTMENT OF REVENUE 
                                              Denver CO 80261-0006 
*DO=NOT=SEND*                                 Colorado.gov/Tax

                                              2019 Amended Colorado Oil and Gas Severance 
                                                                                Tax Return

                                                                            DR 0021X Instructions

The Amended Colorado Oil and Gas Severance Tax Return               a mutual fund, brokerage firm, or credit union) in the United 
(DR 0021X) is required to be used when correcting your              States.
Colorado Oil and Gas Severance Tax Return (DR 0021).                How do I use Direct Deposit?
                                                                    The routing number must be nine digits. The account number 
Statute of Limitations                                              can be up to 17 characters (both numbers and letters). Include 
The statute of limitations for filing a Colorado severance tax      hyphens but omit spaces and special symbols.
claim for refund is generally three years from the due date of the 
original return or three years from the date of last tax payment 
for the year involved, whichever is later.
Refund for Deceased Taxpayer
To request a refund for a deceased taxpayer, write “deceased” 
across the top of the return and the date of death next to the 
deceased person’s name. Additionally, you must sign the 
return and write “filling as surviving spouse” or “filling as legal 
representative” by your signature.
Any person other than the surviving spouse who files a return 
and requires a refund on behalf of a deceased person must 
attach a copy of the death certificate and the DR 0102, Claim for   You should contact your financial institution to ensure your 
Refund for Deceased Taxpayer.                                       deposit will be accepted and to obtain the correct routing and 
Colorado Account Number                                             account numbers. This is especially important if you want your 
For business accounts, enter your Colorado account number           refund deposited to a savings account at a credit union. The 
and your  Federal Employer Identification Number (FEIN)             Department of Revenue is not responsible for a lost refund if you 
in the spaces provided. For individuals, enter your Social          enter the wrong account information. Any refund claim that, for 
Security number or ITIN.                                            any reason, cannot be deposited into the account specified will 
Lines 11 through 17                                                 be issued and mailed in check form instead.
Compute the amount owed to the state on the amended return.         Interest
Any decrease in the amount of the overpayment (line 11) or          If the return is amended after the original due date of the return, 
increase in the amount owed (line 12) will indicate that an         interest at the applicable statutory rate will accrue on any 
amount is owed with the amended return. To pay the amount           balance of tax due until paid. Interest rates are published on our 
you owe, write your Colorado account number or Federal              web site at Colorado.gov/Tax
Employer Identification Number (FEIN) on your check. Enclose        Penalty
but do not attach your payment with DR 0021X.                       The penalty on any balance of tax due is $30 or 30% of the 
Lines 18 through 21                                                 balance of tax due, whichever is greater.
Compute the amount of credit available on the amended               Reason for amended return
return. Any increase in the amount of the overpayment (line         Attach an explanation and any documentation, including 
18) or decrease in the amount owed (line 19) will indicate that     schedule DR 0021D, and DR 0021PD, if applicable, needed to 
an overpayment is available with the amended return. The            substantiate the changes reported on the amended return.
overpayment can be credited to estimated tax (line 21) for the 
                                                                    Forms and Information
tax year following the period on the amended return, or can be      If you have any questions you may call the Department of 
requested as a refund (line 20).                                    Revenue at (303) 238-SERV (7378) or see our web site at 
Direct Deposit                                                      Colorado.gov/Tax for forms and information.
The department can deposit your refund directly into your 
account at a U.S. bank or other financial institution (such as 



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                                                     DR 0021X (06/26/19) 
                                                     COLORADO DEPARTMENT OF REVENUE 
                                                     Denver CO 80261-0006 
*190021X=19999*                                      Colorado.gov/Tax
                                                     (7102)

                            2019 Amended Colorado Oil and Gas 
                                          Severance Tax Return

For Taxable Year (2019)                   Fiscal Tax Year Beginning (MM/19)                       Fiscal Tax Year Ending (MM/YY)

                 2019
Last Name or Business Name                                                   First Name                                         Middle Initial

                            SSN or ITIN                                  Colorado Account Number (if applicable)
Deceased             Yes
Spouse’s Last Name (see controlled group definition)                         First Name                                         Middle Initial

                            SSN or ITIN                                   FEIN (if applicable)
Deceased             Yes
Address

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 form when you file     Round to the 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 forms DR 0021W                                    4             $                               00

5. Estimated tax and extension payments                                             5             $                               00

6. Total Prepayments, add lines 4 and 5                                             6             $                               00
Stop Stop here to let the department calculate your refund or balance due. Otherwise, manually complete the return 
     yourself and continue with line 7. 

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

8. Enter the overpayment from your original return or as previously adjusted        8             $                               00

9. If line 3 is larger than line 6, enter the amount owed                           9             $                               00

10. Enter the amount owed from your original return or as previously adjusted   10                $                               00



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                                                 DR 0021X (06/26/19) 
                                                 COLORADO DEPARTMENT OF REVENUE 
                                                 Denver CO 80261-0006 
*190021X=29999*                                  Colorado.gov/Tax
Compute the amount you owe

11. Line 8 minus line 7, but not less than zero                                     11 $                         00

12. Line 9 minus line 10, but not less than zero                                    12 $                         00

13. Additional tax due, total of lines 11 and 12                                    13 $                         00

14. Interest due on additional tax                                                  14 $                         00

15. Penalty due                                                                     15 $                         00

16. Estimated tax penalty due                                                       16 $                         00
                                                               
17. Payment due with this return, add lines 13 through 16           Paid by EFT     17
                                                                                       $ 
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.
Compute your refund

18. Line 7 minus line 8 but not less than zero                                      18 $                         00

19. Line 10 minus line 9, but not less than zero                                    19 $                         00

20. Refund claimed with this return, total of lines 18 and 19                       20 $                         00
21. Overpayment credited to next year’s estimated tax 
      (Do not include this amount on line 20)                                       21 $                         00

                    Routing Number                                          Type:     Checking Savings
      Direct
      Deposit       Account Number

Reason for Amendment

Last Name of person preparing return                             First Name                                Middle Initial

Address of person preparing return                                          Phone Number

City                                                                                           State    Zip

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)

      Mail to and make checks payable to:   Colorado Department of Revenue 
                                                 Denver, CO 80261-0006






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