DR 7011 (03/10/10)
COLORADO DEPARTMENT OF REVENUE

DR 7011 (09/04/13)
COLORADO DEPARTMENT OF REVENUE                 Passenger Mile                           *137011==19999*
                                       Detail By Passenger Buses
Use this form to calculate your "Passenger Mile Tax" to be entered on line 1 of your Passenger Mile and Special Fuel User 
Tax Return (DR 0133). You must retain this passenger mile detail in your own records and make it available to the Colorado 
Department of Revenue upon request.
PASSENGERInstructions—For EachMILETrip Provide:DETAIL BY PASSENGER6)  The Number of PassengersBUSES
1)  The Date of the Trip                                             For each trip, multiply the Colorado miles in column 
2)  The Vehicle I.D. or Unit Number                                  5 times the number of passengers in column 6 to 
3)  The Point of Departure                                           determine the taxable passenger miles. Enter this 
4)  The Final Destination (treat each stopping point at              figure in column 7. Photocopy this form if additional 
  which you load or unload passengers as a "Final                    lines are needed.
  Destination," even though you might be continuing on               Add all the numbers in column 7 to determine the total 
  with the same vehicle.)                                            passenger miles for the reporting period. Enter this 
5)  Miles Traveled in Colorado                                       number on line 8 at the bottom of this form.
Last Name or Taxpayer Name                     First Name            Middle initial Account Number Period (MM/YY - MM/YY)
                                                                                                                 —

                  (2) Vehicle                                        (5) Miles Traveled (6) Number (7) Passenger 
  (1) Date                             (3) From               (4) To                          of                 Miles
                  I.D. Number                                        in Colorado        Passengers (Line 5 x Line 6)

                                                                        Total Passenger Miles 

Enter this figure on Line 1 of DR 0133                                                  x $.001=