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DR 0021W (06/10/22)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0006
*DO=NOT=SEND* 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 Enter the amount of ad valorem tax on both
Line 6 Enter the total gross income (before 1% cash and accrual basis. For cash basis, report
withholding, ad valorem, etc.,) made to the only ad valorem taxes actually paid to the
county assessors during the year. For accrual
interest owner on both a cash basis and
accrual basis. For cash basis, report all basis, report the actual ad valorem tax amount
payments made during the year even if they are assessed at the mill levy date (usually in
for prior period production or are take or pay November or December) within the year.
payments for future production. For accrual Line 9 Enter that amount of ad valorem tax for both the
basis, report payments on all production during cash and accrual basis that related to oil and
the calendar year, even if they are not disbursed gas production from a stripper well.
Line 10
to the interest owner within the year. Enter amount of severance tax actually withheld
Line 7 Enter that portion of payments, on both the cash and remitted to Colorado Department of Revenue
and accrual basis, that are from tax-exempt oil for the calendar year.
and gas production from a stripper well. Enter information as required.
Box 11
and 12
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 You must attach one copy of this form to your “Colorado
and gas produced in Colorado is required to pay severance Severance Tax Return” (DR 0021) in order to claim credits.
tax. Every producer or first purchaser is required to If you need additional information about severance tax, see
withhold 1% of the gross income paid to every owner, and publication FYI General 4, "Severance Tax Information for
to supply an Oil and Gas Withholding Statement by March Owners of any Interest in any Oil and Gas Produced in
1 of each year. Colorado," on our Web site Tax.Colorado.gov
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.
