DR 0021S (07/08/22) 
                                             COLORADO DEPARTMENT OF REVENUE                                     (7040)
                                             Denver CO 80261-0008
*220021S=19999*                              Tax.Colorado.gov
                                             Page 1 of 1

                        2022 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 
will be assessed. If 90% or more of the net tax liability is paid 
by the original due date of the return and the balance is paid       payment form must be the same. This will help maintain 
when the return is filed by the last day of the extension period,    accuracy in your tax account.
only interest will be assessed.                                      Submit the DR 0021S with payment to:
Use the DR 0021S to make a payment that must be made                                Colorado Department of Revenue 
by the original due date of the return to meet the 90%                              Denver, CO 80261-0008
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 (07/08/22)
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/22)                                              Ending: (MM/YY)

Your Last Name or Business 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.                              $