Dr 0021W Form PDF Details

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QuestionAnswer
Form NameDr 0021W Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names DR 0021W

Form Preview Example

*DO=NOT=SEND*

DR 0021W (08/20/20)

COLORADO DEPARTMENT OF REVENUE

Denver CO 80261-0006

Tax.Colorado.gov

Instructions for Producers and First Purchasers Preparing DR 0021W for Severance Taxpayers

See form on Page 2

Box 1–5 Enter the information requested.

Line 8

Line 6 Enter the total gross income (before 1% withholding,

 

advalorem,etc.,)madetotheinterestowneronboth

 

a cash basis and accrual basis. For cash basis,

 

report all payments made during the year even if

 

they are for prior period production or are take or

 

pay payments for future production. For accrual

 

basis, report payments on all production during the

Line 9

calendar year, even if they are not disbursed to the

 

interest owner within the year.

 

Line 7 Enter that portion of payments, on both the cash

Line 10

and accrual basis, that are from tax-exempt oil

 

and gas production from a stripper well.

 

 

Box 11

 

and 12

Enter the amount of ad valorem tax on both cash and accrual basis. For cash basis, report only ad valoremtaxesactuallypaidtothecountyassessors during the year. For accrual basis, report the actual ad valorem tax amount assessed at the mill levy date (usually in November or December) within the year.

Enter that amount of ad valorem tax for both the cash and accrual basis that related to oil and gas production from a stripper well.

Enteramountofseverancetaxactuallywithheldand remitted to Colorado Department of Revenue for the calendar year.

Enter information as required.

This form may be reproduced in this format in a manner compatible with computer generation.

Instructions for Recipients of DR 0021W

Any producer, working, royalty or other interest owner of oil

and gas produced in Colorado is required to pay severance tax. Every producer or first purchaser is required to

withhold 1% of the gross income paid to every owner, and to supply an Oil and Gas Withholding Statement by March 1 of each year.

This Oil and Gas Withholding Statement form lists your

gross income from the property indicated and the amount the producer or first purchaser has withheld. It also lists

your share of any ad valorem taxes paid.

You must attach one copy of this form to your “Colorado Severance Tax Return” (DR 0021) in order to claim credits.

If you need additional information about severance tax, see publication FYI General 4, "Severance Tax Information for Owners of any Interest in any Oil and Gas Produced in Colorado," on our Web site Tax.Colorado.gov

*200021W=19999*

DR 0021W (08/20/20)

COLORADO DEPARTMENT OF REVENUE

Denver CO 80261-0006

Tax.Colorado.gov

Page 1 of 1

2020 Oil and Gas Withholding Statement

Colorado Severance Tax Withheld from Oil Shale and Oil/Gas Payments

For Calendar Year

1.

Well Name

 

 

2. Lease

 

 

 

 

 

 

 

 

 

3.

Field

4. County

 

 

5. American Petroleum Institute Well Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cash Basis

Accrual Basis

6.

Gross Income

 

 

$

 

$

7.

Gross income attributable to stripper well production

 

$

 

$

8.

Ad valorem tax on oil and gas production

 

$

 

$

9.

Ad valorem tax attributable to stripper well production

 

$

 

$

10.Severance tax withheld

$

If filing on a fiscal period, this information is not correct. Consult your distribution statements or payor for correct amounts.

11. Last Name of Payee

 

First Name

 

Middle Initial

 

 

 

 

 

 

 

SSN or ITIN

 

Colorado Account Number

FEIN

 

 

 

 

 

 

 

Address of Payee

 

City

 

 

 

 

 

 

 

 

 

State

 

Zip

Foreign Country

 

 

 

 

 

 

 

 

12. Last Name of Payor

 

First Name

 

Middle Initial

 

 

 

 

 

 

SSN or ITIN

 

Colorado Account Number

FEIN

 

 

 

 

 

 

Address of Payor

 

City

 

 

 

 

 

 

 

 

State

Zip

Foreign Country

 

 

Note to Payor: Attach one copy to the DR 0456. Retain a copy for your records. Submit two copies to the payee.

How to Edit Dr 0021W Form Online for Free

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Step 1: Just click the "Get Form Button" above on this page to start up our pdf form editor. Here you will find all that is required to fill out your document.

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As for the blank fields of this precise PDF, this is what you want to do:

1. It is recommended to fill out the Dr 0021W Form properly, hence take care while filling out the sections that contain all these blanks:

Dr 0021W Form writing process clarified (stage 1)

2. After this section is done, proceed to enter the relevant details in these: Address of Payee, Last Name of Payor, SSN or ITIN, Address of Payor, State, Zip, Foreign Country, City, First Name, Middle Initial, Colorado Account Number, FEIN, City, State, and Zip.

Step number 2 of filling in Dr 0021W Form

Always be very attentive while completing First Name and Middle Initial, since this is where a lot of people make some mistakes.

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