Form DR 1210 Fillable Estate Tax Return
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(01) $ (09) $ (999)$ (Attach copy of return Provide evidence of payment as soon as possible ) (identify on attached Federal estate tax return) 1 Total State death tax credit allowable for Federal estate tax purposes 10 Tax payable to Colorado (line 6 multiplied by line 9) Enter on line 11 below 10 yr 15 yr 11 Amount of tax payable to Colorado (Schedule A line 5 or Schedule B line 5 plus line 10) 12 Penalties: 13 Interest at % from to 1375 SHERMAN STREET 14 Total tax penalty and interest payable (total of lines 11 12 and 13) 15 Prior payments (attach explanation) 16 Balance due (line 14 minus line 15) 2 Gross value for Federal estate tax purposes of property located in Colorado 2 Taxes paid to other states qualifying for Federal estate tax State death tax credit 3 Gross value of decedent's estate for Federal estate tax purposes 3 Proration of Federal estate tax State death tax credit: 4 Deduction for taxes paid to other states (line 2 or line 3d whichever is smaller) 4 Percent of Federal estate located in Colorado (line 2 divided by line 3) 5 Tax payable to Colorado (line 1 less line 4) Enter on line 11 below 5 Tax payable to Colorado (line 1 multiplied by line 4) Enter on line 11 below 6 Total State death tax credit allowable for Federal generation skipping transfer tax 7 Gross value for Federal generation skipping transfer tax purposes of property located in 8 Gross value of estate for Federal generation skipping transfer tax purposes 9 Percent of property subject to Federal generation skipping transfer tax located in A Federal return is attached and a Colorado estate tax is due A Certificate of Estate A Federal return is attached but no Colorado estate tax is due A Certificate of A Federal return is not required to be filed but a Certificate of Estate Tax Determination a Gross value for Federal estate tax purposes of property in states other A true copy of such approved extension is attached Extension date: ACCOUNT NUMBER: L2126495 PERIOD LIABILITY: 2800 800 Alien An extension of time to file the Federal return has has not been approved An extension of time to pay the Federal tax has has not been approved APPLICABLE STATEMENT LISTED BELOW: Attached is a payment for Colorado tax in amount b Gross value of decedent's estate for Federal estate tax purposes be assessed c Percent of estate for Federal estate tax purposes located in states other City State Zip Telephone City State Zip Telephone: Colorado (identify on attached Federal generation skipping transfer tax return) Colorado (line 1 multiplied by line 3c ) Colorado (line 7 divided by line 8) Colorado Assets COLORADO DEPARTMENT OF REVENUE COLORADO ESTATE TAX RETURN d Amount of credit attributable to property located in states other than Date of death on or after January 1 1986: Date of death prior to January 1 1986: Decedent was: DENVER CO 80261 Department of Revenue Use Only Domicile at Date of Death (Number and Street) City County State Zip Domiciliary DR 1210 (10/03) DUE DATE: ON OR BEFORE THE DATE THE Enter the total gross value of the decedent's estate Gross value means the total value of assets before any deductions Estate of Date of Death Decedent's Social Security Number Estate Tax Determination is requested Complete Sections I and II below First payment due date: FOR DEPARTMENT USE ONLY I declare under penalties of perjury in the second degree that I have examined this return including any and all accompanying installment payments is requested Complete Sections I and II below Late filing penalty (5% for each month or portion thereof maximum penalty 20%) Late filing penalty (5% for each month or portion thereof maximum penalty 25%) Late payment penalty (the greater of $15 00 or 5% for each month or portion Name of Attorney Address (Number and Street) Name of Personal Representative or person filing return Address (Number and Street) Non Colorado Assets Non Domiciliary NOTE: If the late filing and late payment penalties both apply only one of the two shall of Colorado purposes RECAPITULATION Recapitulation page 2 SCHEDULE A Computation of Tax Domiciliary Decedent's Estate Federal Estate Tax SCHEDULE B Computation of Tax Non Domiciliary or Alien Decedent's Estate Federal Estate Tax SCHEDULE C Computation of Tax Generation Skipping Transfer Tax schedules or attachments and that I believe the same to be true and correct as to every material matter SECTION I SECTION II Signature of person filing return Title Date Signature of person preparing return Title Date Tax Determination is requested than Colorado (identify on attached Federal tax return) than Colorado (line 3a divided by line 3b ) The amount of payment was computed in accordance with Schedule A B C and The Estate has elected thereof maximum penalty 20%) TO BE FILED ONLY IF DATE OF DEATH IS ON OR AFTER JANUARY 1 1980 CHECK THE TOTAL www taxcolorado com FEDERAL RETURN IS REQUIRED TO BE FILED