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                                        DR 0100 (09/27/21) 
                                        COLORADO DEPARTMENT OF REVENUE      Colorado Retail 
                                        Denver CO 80261-0013 
*DO*NOT*SEND*                           Tax.Colorado.gov                    Sales Tax Return

General Information                                                Department  before  filing  returns  with  an  Excel 
Retailers must file a sales tax return for every filing period,    spreadsheet.  Information  can  be  found  online  at  
even if the retailer made no sales during the period and no        Tax.Colorado.gov/sales-tax-spreadsheet-filing.
tax is due. Typically, returns must be filed on a monthly basis. 
See Part 7: Filing and Remittance in the Colorado Sales Tax      Payment Information
Guide for additional information regarding filing frequency.     The Department offers retailers several payment options for 
                                                                 remitting sales taxes.
A separate return must be filed for each business site or 
location at which a retailer makes sales. If a retailer fails to Electronic Payments
file a return for any filing period, the Department will estimate  Regardless of whether they file electronically or with a paper 
the tax due and issue to the retailer a written notice of the  return, retailers can remit payment electronically using one 
estimated tax due. The Department may deactivate the sales  of  two  payment  methods.  Retailers  who  remit  electronic 
tax account of a retailer who fails to file returns for successive  payments should check the appropriate box on line 18 of the 
filing periods.                                                  return to indicate their electronic payment. 
                                                                 EFT Payment         –  Retailers  can  remit  payment  by 
Electronic Filing Information
                                                                   electronic funds transfer (EFT) via either ACH debit 
The Department offers multiple electronic filing options that 
                                                                   or ACH credit. There is no processing fee for EFT 
retailers may use as an alternative to filing paper returns.
                                                                   payments.  Retailers  must  register  prior  to  making 
Revenue Online – Retailers must first create a Revenue           payments  via  EFT  and  will  not  be  able  to  make 
  Online account to file returns through Revenue Online.           payments via EFT until 24-48 hours after registering. 
  Retailers who file returns through Revenue Online must           See  Electronic  Funds  Transferred  (EFT)  Program 
  file separate returns for each of the retailer’s business        For Tax Payments (DR 5782) and Electronic Funds 
  sites or locations. Revenue Online can be accessed at            Transfer (EFT) Account Setup For Tax Payments (DR 
  Colorado.gov/RevenueOnline.                                      5785) for additional information.
XML Filing – Retailers may file returns electronically in      Credit Card and E-Check –  Retailers  can  remit 
  an XML (Extensible Markup Language) format using                 payment  electronically  by  credit  card  or  electronic 
  any of the approved software options listed online               check  online  at   Colorado.gov/RevenueOnline.  A 
  at  Tax.Colorado.gov/software-developers-sales-tax.              processing fee is charged for any payments remitted 
  Retailers do not need to obtain any special approval             by credit card or electronic check.
  from  the  Department  to  file  using  an  approved 
                                                                 Paper Check
  software option.
                                                                 Regardless of whether they file electronically or with a paper 
Spreadsheet Filing – Retailers may file electronically  return,  retailers  can  remit  payment  with  a  paper  check. 
  using  an  approved  Microsoft  Excel  spreadsheet.  Retailers should write “Sales Tax,” the account number, and 
  Each  retailer  must  obtain  approval  from  the  the filing period on any paper check remitted to pay sales tax 



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                                     DR 0100 (09/27/21) 
                                     COLORADO DEPARTMENT OF REVENUE 
                                     Denver CO 80261-0013 
*DO*NOT*SEND*                        Tax.Colorado.gov

to ensure proper crediting of their account.                    Form Instructions
Paper Return  –  Retailers  who  file  a  paper  return       In preparing a sales tax return, a retailer must include its 
  can mail a paper check with the return to pay the tax         identifying information (such as name and account number), 
  reported on the return.                                       the filing period and due date, and information about sales 
                                                                and exemptions in order to calculate the tax due. Specific 
Electronic  Filing  Through  Revenue  Online          – A 
                                                                instructions for preparing sales tax returns appear below and 
  retailer  who  files  electronically  through  Revenue 
                                                                on the following pages.
  Online can remit payment by paper check. Once the 
  electronic return has been submitted, the retailer can        SSN and FEIN
  select “Payment Coupon” for the payment option to  Retailers must provide a valid identification number, issued by 
  print a payment processing document to send along  the federal government, when filing a sales tax return. If the 
  with their paper check.                                       retailer is a corporation, partnership, or other legal entity, this 
                                                                will generally be a Federal Employer Identification Number 
Physical And Non-Physical Sites                                 (FEIN). If the retailer is a sole proprietorship, a Social Security 
A  retailer  is  required  to  obtain  a  sales  tax  license  and  number (SSN) will generally be used instead. 
file separate sales tax returns for each separate place of 
business at which the retailer makes sales (a “physical         Colorado Account Number
site”). Additionally, if a retailer delivers taxable goods or   Retailers must enter their Colorado account number on each 
services  to  a  purchaser  at  any  location  other  than  the return, including both their eight-digit account number and the 
retailer’s place of business, the retailer must register with   four-digit site/location number (for example: 12345678-0001). 
the  Department  a  “non-physical  site”  for  each  location   If a retailer makes sales at different locations, the retailer 
jurisdiction code into which goods or services are delivered    must file a separate return for each location. Returns must 
(see Department publication Location/Jurisdiction Codes         also be filed for each location jurisdiction code area into which 
for  Sales  Tax  Filing  (DR  0800)  for  information  about    the retailer makes deliveries during the tax period. The eight-
location jurisdiction codes). A “non-physical site” is required digit account number will be the same for each location or 
for deliveries even if the retailer has a physical site within  site, but the four-digit site/location number will be unique for 
the same location jurisdiction code.  A separate return must    each location or site. 
be filed for each physical site and each non-physical site.  If you have applied for your license, but do not have your 
                                                                account number, please contact the Customer Contact Center 
Filing A Paper Return                                           at (303) 238-7378 for assistance.
Retailers electing to file a paper return must sign, date, and 
mail the return, along with their payment, if applicable, to:   Period
  Colorado Department of Revenue                                Retailers must indicate the filing period for each return. The 
  Denver CO 80261-0013                                          filing period is defined by the first and last months in the filing 
                                                                period and entered in a MM/YY-MM/YY format. For example:
Retailers are required to keep and preserve for a period of 
three years all books, accounts, and records necessary to       •  For a monthly return for January 2020, the filing period 
determine the correct amount of tax.                            would be 01/20-01/20.
                                                                •  For a quarterly return for the first quarter (Jan. through 
Items Removed From Inventory                                    March) of 2020, the filing period would be 01/20-03/20.
Any tangible personal property a retailer purchased for resale, 
but subsequently removed from inventory for the retailer’s      •  For an annual return filed for 2020, the filing period 
own use, is subject to consumer use tax. A Consumer Use         would be 01/20-12/20.
Tax Return (DR 0252) is required to report and remit any 
                                                                Location Juris Code
consumer use tax a retailer owes.
                                                                Retailers must enter the six-digit location jurisdiction (juris) 
Additional Resources                                            code to identify the site/location of sales reported on the 
Additional sales tax guidance and filing information can be     return. For physical site/locations, the code appears on the 
found online at Tax.Colorado.gov. These resources include:      retailer’s  Sales  Tax  License  under  'Liability  Information.' 
                                                                A complete listing of location juris codes can be found in 
•  Colorado Sales Tax Guide
                                                                Department publication Location/Jurisdiction Codes for Sales 
•  Sales tax classes and videos available online at  Tax Filing (DR 0800).
  Tax.Colorado.gov/education.
                                                                Due Date
•  The Customer Contact Center, which can be contacted          Retailers must enter the due date for the return. Returns are 
  at (303) 238-7378.                                            due the 20th day of the month following the close of the filing 
                                                                period. If the 20th is a Saturday, Sunday, or legal holiday, the 
                                                                return is due the next business day.



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                                                                     DR 0100 (09/27/21) 
                                                                     COLORADO DEPARTMENT OF REVENUE 
                                                                     Denver CO 80261-0013 
*DO*NOT*SEND*                                                        Tax.Colorado.gov

Monthly Returns: due the 20th day of the month following the  cannot be reported and remitted with the DR 0100. Retailers 
reporting month.                                                                                       must report such taxes directly to the applicable city.
Quarterly Returns:                                                                                     See Department publication Colorado Sales/Use Tax Rates 
          1st quarter (January – March): due April 20                                                  (DR 1002) for tax rates, service fee rates, and exemption 
                                                                                                       information  for  state  and  state-administered  sales  taxes. 
          2nd quarter (April – June): due July 20
                                                                                                       This  publication  also  contains  a  list  of  self-administered 
          3rd quarter (July – September): due October 20                                               home-rule cities.
          4th quarter (October – December): due January 20
                                                                                                       Avoiding Common Filing Errors
Annual Returns: (January – December): due January 20                                                   You can avoid several common errors by reviewing your 
                                                                                                       return before filing it to verify that: 
Amended Returns
If a retailer is filing a return to amend a previously filed return, the                                  •  You completed all applicable lines of the return. 
retailer must mark the applicable box to indicate that the return                                         •  You completed all three pages of the return, including 
is an amended return. A separate amended return must be filed                                             Schedule A and Schedule B. You must complete and 
for each filing period and for each site/location. The amended                                            submit all three pages when filing your return, even if 
return replaces the original return in its entirety and must report                                       you have no deductions or exemptions to report on 
the full corrected amounts, rather than merely the changes in                                             Schedule A or Schedule B. 
the amount of sales or tax due. If the amended return reduces 
the amount of tax reported on the original return, the retailer                                           •  You used the correct version of the form, depending 
must file a Claim for Refund (DR 0137) along with the amended                                             on the filing period. There are different versions of the 
return to request a refund of the overpayment. If the amended                                             sales tax return for each year 2016 through 2020.  
return is filed after the due date and reports an increase in the                                         •  You entered your account number and site number 
amount of tax due, penalties and interest will apply.                                                     correctly on your return. 
State and State-Collected Local Sales Taxes                                                               •  You  used  the  correct  tax  rate  for  each 
The Colorado Retail Sales Tax Return (DR 0100) is used                                                    jurisdiction  reported  on  your  return.  See  
to report not only Colorado sales tax, but also sales taxes                                               Tax.Colorado.gov/how-to-look-up-sales-use-tax-rates   
administered by the Colorado Department of Revenue for                                                    for information about state and local tax rates. 
various cities, counties, and special districts in the state. The                                      Additional information about common filing errors can be 
sales taxes for different local jurisdictions are calculated and                                       found online at Tax.Colorado.gov/sales-tax-filing-information.
reported in separate columns of the DR 0100. Local sales 
taxes reported on the DR 0100 include:                                                                 Specific Line Instructions
        RTD/CD – Sales taxes for the Regional Transportation                                         Retailers must complete all applicable lines, including lines 1, 
          District (RTD) and the Scientific and Cultural Facilities                                    2, 3, 4, 14, and 18, entering 0 (zero), if applicable. Retailers 
          District (CD) are reported in the RTD/CD column of                                           must also include Schedules A and B for each site/location.  

          the DR 0100.                                                                                 Line 1. Gross sales of goods and services for this site/
        Special District – Special district sales taxes reported                                     location only
          in the Special District column include sales taxes for  Enter the gross sales of goods and services made during 
          any Regional Transportation Authority (RTA), Multi-                                          the filing period. Include only sales sourced pursuant to state 
          Jurisdictional  Housing  Authority  (MHA),  Public  law to the site/location indicated on the return.                                     See Part 7: 
          Safety  Improvements  (PSI),  Metropolitan  District                                         Retail Sales in the Colorado Sales Tax Guide for additional 
          Tax  (MDT),  or  Health  Services  District  (HSD).   information regarding sourcing.                                      
          Sales  taxes  for  Mass  Transportation  Systems                                             For small retailers subject to origin sourcing rules, include 
          (MTS)  and  Local  Improvement  Districts  (LID)  are                                        all  sales  made  from  the  retailer’s  physical  site/location, 
          not reported in the Special District column, but are                                         regardless of whether the property or service is delivered to 
          instead reported in the County/MTS and City/LID                                              the purchaser at another location. 
          columns, respectively.
                                                                                                       For all other retailers who are subject to destination sourcing 
        County/MTS               –  County  and  Mass  Transportation                                rules, do not include on a return for any physical site any 
          Systems  (MTS)  sales  taxes  administered  by  the                                          sales delivered to the purchaser and sourced for sales tax 
          Department are reported in the County/MTS column.                                            purposes to another location.  For non-physical sites, include 
        City/LID – City and Local Improvement Districts (LID)  all sales delivered and sourced to the location jurisdiction 
          sales  taxes  administered  by  the  Department  are  code associated with the non-physical site.
          reported in the City/LID column. 
                                                                                                       Include all sales of goods and services, whether taxable or 
Many home-rule cities in Colorado administer their own sales  not, and the collection during the filing period of any bad 
taxes. Sales taxes for these self-collected home-rule cities  debts deducted on a return filed for a previous filing period.



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                                      DR 0100 (09/27/21) 
                                      COLORADO DEPARTMENT OF REVENUE 
                                      Denver CO 80261-0013 
*DO*NOT*SEND*                         Tax.Colorado.gov

Line 6. Tax rate                                                      Limit on state service fee
Enter the applicable state, city, county, and/or special district  The total combined Colorado state service fee allowed to a 
tax rate in each column of the return. The Colorado state  retailer for any given filing period is limited to $1,000. The 
sales tax rate is 2.9%. The sales tax rates for each city,  retailer should enter on line 11 the full amount calculated by 
county,  and  special  district  can  be  found  in  Department  multiplying the amount on line 9 times the rate on line 10, but 
publication  Colorado  Sales/Use Tax  Rates  (DR  1002)  or  if the combined Colorado state service fee calculated on the 
online at Colorado.gov/RevenueOnline.                                 retailer’s sales tax returns for all sites/locations for the filing 
                                                                      period exceeds $1,000, the retailer must complete the State 
Line 8. Excess tax collected                                          Service Fee Worksheet (DR 0103). The worksheet is used 
Enter any tax collected in excess of the tax due as computed          to determine what amount, if any, the retailer must pay in 
on line 7. For example, if the retailer collected $50 of county       addition to the total balance due calculated on line 18 of the 
sales  tax  during  the  filing  period,  but  only  $45  of  tax  is retailer’s returns. The amount of additional tax calculated on 
calculated  in  the  County/MTS  column  of  the  return,  the        the State Service Fee Worksheet (DR 0103) should not be 
excess $5 of tax collected must be reported on this line.             entered anywhere on the retailer’s Colorado Retail Sales Tax 
                                                                      Return (DR 0100).
Line 10. Service fee rate
Enter the applicable service fee rate in each column of the return.  Beginning January 1, 2022, a retailer with total state net 
The Colorado state service fee rate is 4%. Service fee rates for  taxable sales (Column 1, line 5 or the sum of Column 1, 
each city, county, and special district can be found in Department  line  5  across  all  sites),  greater  than  $1,000,000  is  not 
publication Colorado Sales/Use Tax Rates (DR 1002).                   eligible to retain the state vendor's fee. 

Line 11. Service fee                                                  Line 13. Credit for tax previously paid
The service fee is calculated by multiplying the amount on  If a retailer overpaid tax on any previously filed return for a 
line 9 by the rate on line 10. The full amount calculated should  different filing period, and a refund claim for such overpayment 
be entered on line 11, unless the return is filed after the due  is not barred by the statute of limitations, the retailer may 
date or possibly if the return is an amended return. Both of  claim a credit against tax calculated on the current return 
these situations are addressed in the following instructions.         for such prior overpayment. Credit may be claimed only for 
                                                                      tax overpayments for the same site/location and the same 
If the amount in the state column, line 5 (net taxable sales) is 
                                                                      state or local jurisdiction. No credit may be claimed for an 
$1,000,000 or greater, enter $0.
                                                                      overpayment reflected in Department records either because 
Retailers with multiple sites must add the amounts in the             the  retailer  filed  an  amended  return  or  the  Department 
state column, line 5 for all sites. If the sum is greater than        adjusted the tax for the prior filing period. 
$1,000,000, enter $0.
                                                                      Line 15. Penalty
Timely payment of tax                                                 If any retailer does not, by the applicable due date, file a 
If the tax calculated on the return is paid by the return due date,   return, pay the tax due, or correctly account for tax due, the 
enter on line 11 the service fee calculated by multiplying the  retailer will owe a penalty. The penalty is 10% of the tax plus 
amount on line 9 by the service fee rate on line 10, regardless of  0.5% of the tax for each month the tax remains unpaid, not to 
whether the return is an original or amended return. If the return  exceed a total of 18%.  The minimum penalty amount is $15.
is an original return and the tax is not paid by the due date for the 
return, and therefore no service fee is allowed, enter $0 on line 11. Line 16. Interest
                                                                      If the tax is not paid by the applicable due date, the retailer 
Amended returns                                                       will owe interest calculated from the due date until the date 
If the return is an amended return and the tax reported on the  the tax is paid. See FYI General 11 for interest rates and 
original return was not paid by the due date for the return, the  information about interest calculation.
allowable service fee on the amended return is $0. 
                                                                      Schedule A and Schedule B
If the tax reported on the original return was paid by the due 
                                                                      Schedule A and Schedule B are used to report various 
date and the amended return reports an increase of the tax            deductions and exemptions. Any amounts entered on 
due, the allowable service fee on the amended return is equal         lines 2 or 4 of the return may be disallowed if Schedules 
to the service fee allowed on the original return. Enter on           A and B for each site/location are not completed and 
line 11 of the amended return the service fee allowed on the          included with the return. In general, Schedule A includes 
original return. No additional service fee is allowed for the         deductions and exemptions that are not optional for state-
additional tax reported on the amended return.                        administered local jurisdictions and Schedule B includes 
If the tax reported on the original return was paid by the due date  exemptions  that  are  optional  for  local  jurisdictions. 
and the amended returns reports a decrease of the tax due,  See the Supplemental Instructions available online at 
enter on line 11 the amount calculated by multiplying the amount      Tax.Colorado.gov/sales-tax-filing-information for guidance 
on line 9 of the amended return by the service fee rate on line 10.   regarding specific deductions and exemptions.



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                                                             DR 0100 (09/27/21) 
                                                             COLORADO DEPARTMENT OF REVENUE 
                                                             Denver CO 80261-0013 
*190100==19999*                                              Tax.Colorado.gov

                                        Colorado Retail Sales Tax Return
Signature (Signed under penalty of perjury in the second degree).                                       Date (MM/DD/YY)

SSN 1                                           SSN 2                                   FEIN

Last Name or Business Name                                                   First Name

Address                                                           City            State ZIP             Phone

Colorado Account Number (XXXXXXXX-XXXX)         Period (MM/YY-MM/YY)   Location Juris Code (Refer to form DR 0800) Due Date (MM/DD/YY)
                                                             

Mark here if this is an Amended Return                                                                             0021-103
                                                                                                            (1-1)

1. Gross sales of goods and services for this site/location only 
                                                                                                            (2-1)

2. Total from line 13 of Schedule A     
                                        State                RTD/CD             Special District County/MTS              City/LID
3. Subtract line 2 from line 1  (3-1)                 (3-2)                  (3-3)               (3-4)             (3-5)
   and enter the result in each 
   applicable column 
                                (4-1)                 (4-2)                  (4-3)               (4-4)             (4-5)
4. Total from line 12 of 
   Schedule B 
5. Net taxable sales: 
   Subtract line 4 from line 3 
6. Tax rate
7. Tax on net taxable sales: 
   Multiply line 5 by line 6 
                                (8-1)                 (8-2)                  (8-3)               (8-4)             (8-5)

8. Excess tax collected 

9. Add lines 7 and 8

10. Service fee rate
                                (11-1)                (11-2)                 (11-3)              (11-4)            (11-5)
11. Service fee: Multiply  
     line 9 by line 10 
12. Net tax due: Subtract  
     line 11 from line 9
                               (13-1)                 (13-2)                 (13-3)              (13-4)            (13-5)
13. Credit for tax previously  
     paid 

                             Attention: Continue to pages 2 and 3 to complete your return.
                                                                       Page 1



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                                                                      DR 0100 (09/27/21) 
                                                                      COLORADO DEPARTMENT OF REVENUE 
                                                                      Denver CO 80261-0013 
*190100==29999*                                                       Tax.Colorado.gov
 Colorado Account Number (XXXXXXXX-XXXX) Period (MM/YY-MM/YY)                        Name
                                                                                    

                                   State                              RTD/CD                         Special District County/MTS               City/LID
                            (14-1)                             (14-2)                 (14-3)                          (14-4)             (14-5)
14. Subtract line 13 from  
   line 12 
                            (15-1)                             (15-2)                 (15-3)                          (15-4)             (15-5)

15. Penalty 
                            (16-1)                             (16-2)                 (16-3)                          (16-4)             (16-5)

16. Interest 

17. Add lines 14, 15, and 16
The State may convert your check to a one-time electronic banking transaction. 
State. If converted, your check will not be returned. If your check is rejected due 
Your bank account may be debited as early as the same day received by the           18. Balance due: Add     Paid by EFT 
to insufficient or uncollected funds, the Department of Revenue may collect the        amounts from line 17  
payment amount directly from your bank account electronically.                         in each column                        (355) $
 Schedule A (see instructions)
 This schedule is required if any amount is entered on line 2 of Form DR 0100.
                                                                                                                                   (A1-1)

 1.  Wholesale sales, including wholesale sales of ingredients and component parts
                                                                                                                                   (A2-1)

 2.  Sales made to nonresidents or sourced to locations outside of Colorado
                                                                                                                                   (A3-1)

 3.  Sales of nontaxable services
                                                                                                                                   (A4-1)

 4.  Sales to exempt entities and organizations
                                                                                                                                   (A5-1)

 5.  Sales of gasoline, dyed diesel, and other exempt fuels
                                                                                                                                   (A6-1)

 6.  Sales of exempt drugs and medical devices
                                                                                                                                   (A7-1)

 7.  Fair market value of property received in exchange and held for resale
                                                                                                                                   (A8-1)
 8.  Bad debts charged-off, returned goods, trade discounts and allowances where tax was paid 
     (cash discounts are not allowed)
                                                                                                                                   (A9-1)
 9.  Cost of exempt utilities upon which tax was previously paid (restaurants must complete and 
     attach Form DR 1465)
                                                                                                                                   (A10-1)

 10. Exempt agricultural sales, not including farm and dairy equipment
                                                                                                                                   (A11-1)

 11. Sales of computer software that is not taxable

                                                                                     Page 2



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                                                        DR 0100 (09/27/21) 
                                                        COLORADO DEPARTMENT OF REVENUE 
                                                        Denver CO 80261-0013 
*190100==39999*                                         Tax.Colorado.gov
Colorado Account Number (XXXXXXXX-XXXX)         Period (MM/YY-MM/YY) Name
                                                        
                                                                                                    (A12-1)

12. Other exempt sales (see instructions and identify type(s) of exemption(s) claimed below)
Type(s) of other exemption(s) claimed:

13.  Add lines 1 through 12. Enter the total on line 2 of Form DR 0100.
Schedule B (see instructions)
This schedule is required if any amount is entered on line 4 of Form DR 0100.
1. Sales of food for domestic             State        RTD/CD           Special District County/MTS        City/LID
   home consumption and           (B1-1)        (B1-2)               (B1-3)              (B1-4)     (B1-5)
   food sold through vending 
   machines
                                  (B2-1)        (B2-2)               (B2-3)              (B2-4)     (B2-5)
2. Sales of machinery and 
   machine tools
                                  (B3-1)        (B3-2)               (B3-3)              (B3-4)     (B3-5)
3. Sales of electricity and 
   fuel for residential use
                                  (B4-1)        (B4-2)               (B4-3)              (B4-4)     (B4-5)
4. Sales of farm and dairy 
   equipment
5. Sales of medium and            (B5-1)        (B5-2)               (B5-3)              (B5-4)     (B5-5)
   heavy duty low-emitting 
   vehicles and associated 
   parts and power sources
6. Exempt sales made              (B6-1)        (B6-2)               (B6-3)              (B6-4)     (B6-5)
   by schools, school 
   organizations, or 
   charitable organizations
                                  (B7-1)        (B7-2)               (B7-3)              (B7-4)     (B7-5)

7. Sales of cigarettes                    N/A           N/A
                                  (B8-1)        (B8-2)               (B8-3)              (B8-4)     (B8-5)
8. Sales of renewable 
   energy components
                                  (B9-1)        (B9-2)               (B9-3)              (B9-4)     (B9-5)
9. Sales of property for use 
   in space flight
10. Sales of retail               (B0-1)        (B0-2)               (B0-3)              (B0-4)     (B0-5)
     marijuana and retail  
     marijuana products
11. Other exempt sales (see       (B11-1)       (B11-2)              (B11-3)             (B11-4)    (B11-5)
     instructions and identify  
     type(s) of exemption(s)  
     claimed below)
Type(s) of other exemption(s) claimed:

12. Add lines 1 through 11  
     of each column. Enter  
     the total on line 4 of Form  
     DR 0100.

                                                              Page 3






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