*210104AD19999* DR 0104AD (10/22/21) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 1 of 2 2021 DR 0104AD – Subtractions from Income Schedule If claiming a subtraction and filing by paper, you must submit this schedule with your return. Use this schedule to report any subtractions from your Federal Taxable Income. These subtractions will change your Colorado Taxable Income from the amount of Federal Taxable Income. See instructions in the income tax booklet for additional guidance on completing this schedule. Do not enter negative amounts. You must submit this form along with the DR 0104 if claiming any subtractions. Name SSN or ITIN Subtractions from Federal Taxable Income 1. State Income Tax Refund from federal income tax form 1040, 1040 SR, or 1040 SP, Schedule 1 line 1. 1 0 0 2. U.S. Government Interest 2 0 0 3. Primary Taxpayer Pension, Annuity, IRA, Social Security, or Disability Income (see instructions) Deceased SSN or ITIN 3 0 0 4. Spouse Pension, Annuity, IRA, Social Security, or Disability Income (see instructions) Deceased SSN or ITIN 4 0 0 5. Primary Taxpayer Military Retirement Benefits (under age 55), you must submit copies of all 1099R statements with your return. (see instructions) 5 0 0 6. Spouse Military Retirement Benefits (under age 55), you must submit copies of all 1099R statements with your return. (see instructions) 6 0 0 7. Colorado Capital Gain Subtraction 7 0 0 8. CollegeInvest Contribution: (see instructions) Owner’s SSN or ITIN 8 0 0 Total Contribution Owner’s Name 9. Qualifying Charitable Contribution Total Contribution 9 $ 0 0 10. Qualified Reservation Income 10 0 0 11. PERA/DPSRS Subtraction, for PERA contributions made in 1984–1986 or DPSRS contributions made in 1986 11 0 0

*210104AD29999* DR 0104AD (10/22/21) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 2 of 2 Name SSN or ITIN 12. Railroad Benefit Subtraction 12 0 0 13. Wildfire Mitigation Measures Subtraction 13 0 0 14. Colorado Marijuana Business Deduction

14 0 0 15. Non-Resident Disaster Relief Worker Subtraction

15 0 0 Natural Disaster: Enter the executive order number(s) from the Colorado governor’s office that declared the state disaster emergency “D YYYY-###” (see instructions) 16. Reacquisition of Colorado Residency During Active Duty Military Service Subtraction 16 0 0 17. First Time Home Buyer Savings Account Interest Deduction, you must submit form DR 0350(s) with your return 17 0 0 18. Other Subtractions, explain below 18 0 0 Explain 19. Subtractions Allowed Under HB21-1002 (see instructions) 19 0 0 20. Subtotal, sum of lines 1 through 19, transfer the amount to line 6 on the DR 0104 20 0 0