DR 0021AS (08/11/20)
                                          COLORADO DEPARTMENT OF REVENUE
                                          Denver CO 80261-0006
*DO=NOT=SEND*                             Tax.Colorado.gov

Colorado Severance Tax Affiliations Schedule Instructions
                     (see page 2 for form)

For Colorado severance tax purposes, persons        A controlled group of corporations is any parent-
who are members of the same controlled group of     subsidiary or brother-sister group of related 
corporations are treated as one taxpayer.           corporations where 50% or more of the beneficial 
                                                    interests in such corporations is owned by the 
The term “controlled group of corporations” has the 
                                                    same or related persons taking into account only 
meaning defined by Section 613A of the Internal 
                                                    persons who own at least 5% of the beneficial 
Revenue Code of 1986.
                                                    interest.

                     Additional forms and information are available at  
                     Tax.Colorado.gov or by calling 303-238-SERV(7378).

                     DR 0021AS (08/11/20)
                     COLORADO DEPARTMENT OF REVENUE
                     Denver CO 80261-0006
*200021AS19999*      Tax.Colorado.gov
                     Page 1 of 1

                     2020 Colorado Severance Tax
                     Affiliations Schedule
 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

 Name of Corporation                      FEIN                             Colorado Account Number

 Address

 Foreign Country      City                                                 State  Zip

                     Include this Schedule with your Severance Tax Return 
                     (Submit Multiple Pages if Needed)