*220104AD19999* DR 0104AD (11/17/22) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 1 of 2 2022 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 Social Security Benefits (including SSDI) received that were included in Federal Taxable Income (see instructions) 3 0 0 4. Primary Taxpayer Pension, Annuity, IRA, or Disability Income (not including SSDI) (see instructions) Deceased SSN or ITIN 4 0 0 5. Spouse Social Security Benefits (including SSDI) received that were included in Federal Taxable Income (See instructions) 5 0 0 6. Spouse Pension, Annuity, IRA, or Disability Income (not including SSDI) (see instructions) Deceased SSN or ITIN 6 0 0 7. Primary Taxpayer Military Retirement Benefits (under age 55), you must submit copies of all 1099R statements with your return. (see instructions) 7 0 0 8. Spouse Military Retirement Benefits (under age 55), you must submit copies of all 1099R statements with your return. (see instructions) 8 0 0 9. Colorado Agricultural Land Capital Gain Subtraction. You must submit a DR 1316 with your return to qualify for this subtraction. 9 0 0 10. CollegeInvest Contribution: (see instructions) Owner’s SSN or ITIN 10 0 0 Total Contribution Owner’s Name 11. Qualifying Charitable Contribution Total Contribution 11 $ 0 0 12. Qualified Reservation Income 12 0 0

*220104AD29999* DR 0104AD (11/17/22) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 2 of 2 Name SSN or ITIN 13. PERA/DPSRS Subtraction, for PERA contributions made in 1984–1986 or DPSRS contributions made in 1986 13 0 0 14. Railroad Benefit Subtraction 14 0 0 15. Wildfire Mitigation Measures Subtraction 15 0 0 16. Colorado Marijuana Business Deduction

16 0 0 17. Non-Resident Disaster Relief Worker Subtraction

17 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) 18. Reacquisition of Colorado Residency During Active Duty Military Service Subtraction 18 0 0 19. First Time Home Buyer Savings Account Interest Deduction, you must submit form DR 0350(s) with your return 19 0 0 20. Other Subtractions, explain below 20 0 0 Explain 21. Carryforward Subtractions Allowed Under HB21-1002 (see instructions) 21 0 0 22. Subtotal, sum of lines 1 through 21, transfer the amount to line 8 on the DR 0104 22 0 0