Form DR 0349 Fillable Remediation of Contaminated Land Credit Use Schedule
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

1 What type of taxpayer are 2 From whom did you 3 Their Social Security 4 Their Colorado Account 5 Date you received the 6 Total credit available 7 Credit you used in prior 8 Credit available for you 9 Credit you are using this a transferee a transferee for you to use (Enter Identification Number Number Number or Federal originator originator receive each credit? to next year Line 8 minus to use this year Line 6 transferor transferor year (Enter the Total on years (Attach additional (Total credit amount available from the Remediation of Contaminated Land Certificate issued by CDPHE) *140349==19999* 10 Credit carried forward 105 Schedule G Line 7 18a if applicable ) 24a or form 112CR line amount transferred OR and only enter Colorado Account Number COLORADO DEPARTMENT OF REVENUE credit Credit Amount Available Credit Use Schedule Date (MM/DD/YY) Denver CO 80261 0005 DR 0349 (08/11/14) e Totals Entity FEIN final page ) First Name For additional information regarding the remediation of contaminated land credit see FYI Income 42 and the form 104CR Line 24b form form 106CR Line 13 or form 112CR Line 18b ) I certify that I meet the requirements of 39 22 526 C R S Last Name or Business Name Line 9 Middle Initial minus Line 7 (Enter the overall totals on the Ownership % pages if necessary Part A: Use Of Credit Complete this part if you are using or carrying forward credit on this tax return Pass Through Entity Name Photocopy and submit additional pages as needed Remediation of Contaminated Land Signature Tax Information Index at www TaxColorado com or contact the Department of Revenue at 303 238 7378 Tax Year Ending the amount received the total credit less the through transfers) Total on form 104CR Line www TaxColorado com you for each credit?