DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 1 of 8 (0013) 2025 Colorado Individual Income Tax Return Residency Status Full-Year Part-Year or Nonresident (or combination of full-year, part-year, or nonresident). You must submit form DR 0104PN with your return. Abroad on due date Taxpayer Information Your Last Name Your First Name Your Middle Initial Date of Birth (MM/DD/YYYY) S S N or I T I N Deceased: Yes - If checked and claiming a refund, you must include the DR 0102 and death certificate with your return. Enter the following information from your current driver license or state identification card. State of Issue Last 4 characters of ID number Date of Issuance (MM/DD/YYYY) Spouse’s Information If Joint, Spouse’s Last Name Spouse’s First Name Spouse’s Middle Initial Date of Birth (MM/DD/YYYY) S S N or I T I N Deceased: Yes - If checked and claiming a refund, you must include the DR 0102 and death certificate with your return. Enter the following information from your spouse’s current driver license or state identification card. State of Issue Last 4 characters of ID number Date of Issuance (MM/DD/YYYY) All pages are required. *250104==19999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 2 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) Contact Information Mailing Address Phone Number City State ZIP Code Foreign Country (if applicable) Dependents If you have more than 5 dependents, you must file electronically. Dependent 1: Child Tax Credit: Yes Deceased: Yes Last Name First Name S S N or I T I N Year of Birth Dependent 2: Child Tax Credit: Yes Deceased: Yes Last Name First Name S S N or I T I N Year of Birth Dependent 3: Child Tax Credit: Yes Deceased: Yes Last Name First Name S S N or I T I N Year of Birth Dependent 4: Child Tax Credit: Yes Deceased: Yes Last Name First Name S S N or I T I N Year of Birth Dependent 5: Child Tax Credit: Yes Deceased: Yes Last Name First Name S S N or I T I N Year of Birth This page is required. *250104==29999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 3 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) To see if you or members of your household qualify for free or reduced-cost health coverage, check this box if: • You are a Colorado resident and at least one person in your household does not have health coverage and • You give permission for the Colorado Department of Revenue to share the information on Form DR 0104EE with Connect for Health Colorado (the Colorado Health Benefit Exchange) and the Department of Health Care Policy & Financing. Round To The Nearest Dollar 1. Federal Taxable Income from your federal income tax form: 1040, 1040 SR, or 1040 SP line 15 00 cents Additions to Federal Taxable Income 2. State Income Tax Addback (see instructions) 3. Qualified Business Income Deduction Addback (see instructions) 4. Standard or Itemized Federal Deduction Addback (see instructions) 5. Business meals deducted pursuant to section 274(k) of the Internal Revenue Code 6. Nonqualified CollegeInvest Tuition Savings Account distributions (see instructions) 7. Nonqualified Colorado ABLE Account distributions (see instructions) 8. Reserved for future use

9. Other Additions, explain (see instructions) Explain: 10. Subtotal, sum of lines 1 through 7 and line 9 This page is required. 1 2 3 4 5 6 7 8 9 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 00 cents 00 cents 10 *250104==39999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 4 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) Colorado Subtractions 11. Subtractions from the DR 0104AD Schedule, line 22, you must submit the DR 0104AD schedule with your return 12. Colorado Taxable Income, subtract line 11 from line 10 Tax, Prepayments and Credits: see 104 Book for full-year tax table and part-year DR 0104PN Schedule 13. Colorado Tax from tax table or the DR 0104PN line 36, you must submit the DR 0104PN with your return if applicable 14. Alternative Minimum Tax from the DR 0104AMT line 8, you must submit the DR 0104AMT with your return 15. Recapture of prior year credits 16. Subtotal, sum of lines 13 through 15 17. Nonrefundable Credits from the DR 0104CR line 65, the sum of lines 17, 18, 19, and 20 cannot exceed line 16, you must submit the DR 0104CR with your return 18. Nonrefundable Enterprise Zone credits used – as calculated, or from the DR 1366 line 26, the sum of lines 17, 18, 19, and 20 cannot exceed line 16, you must submit the DR 1366 with your return 19. Nonrefundable CHIPS Zone Credit from DR 1370, line 22, the sum of lines 17, 18, 19, and 20 cannot exceed line 16, you must submit DR 1370 with your return 20. Strategic Capital Tax Credit from DR 1330, the sum of lines 17, 18, 19 and 20 cannot exceed line 16, you must submit the DR 1330 with your return 21. Net Income Tax, subtract the sum of lines 17, 18, 19, and 20 from line 16 22. Repayment of credit from form DR 0619, lines 4 and 11, you must submit the DR 0619 with your return This page is required. 11 12 13 14 15 16 17 18 20 21 22 19 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 23. Net Tax and Required Repayment, sum of lines 21 and 22 00 cents 23 *250104==49999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 5 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) Tax, Prepayments and Credits (continued): 24. Colorado Income Tax Withheld from W-2s and 1099s, you must submit the W-2s and/or 1099s claiming Colorado withholding with your return 25. Prior-year Estimated Tax Carryforward 26. Estimated Tax Payments, enter the sum of the quarterly payments remitted for this tax year 27. Extension Payment remitted with the DR 0158 28. Other Prepayments: 29. Gross Conservation Easement Credit from the DR 1305G line 33, you must submit the DR 1305G with your return 30. Innovative Motor Vehicle and Innovative Truck Credit for a vehicle you purchased or leased from form DR 0617, you must submit the DR 0617(s) with your return 31. Refundable Credits from the DR 0104CR line 26, you must submit the DR 0104CR with your return 32. Additional credit from form DR 0619, line 3 and 10, you must submit the DR 0619 with your return 33. Subtotal, sum of lines 24 through 32 DR 0104BEP DR 1079 25 26 24 27 28 29 30 31 32 33 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents 00 cents This page is required. *250104==59999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 6 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) Modified Adjusted Gross Income (AGI) for TABOR Sales Tax Refund Lines 34 through 37 are only used to calculate your TABOR amount and do not affect your Colorado tax liability. 34. Federal Adjusted Gross Income from your federal income tax form: 1040, 1040 SR, or 1040 SP line 11a 35. Nontaxable Social Security Income 36. Nontaxable interest income from state and local bonds 37. Sum of lines 34 through 36: Modified AGI for TABOR amount Modified A G I Tiers for TABOR State Sales Tax Refund If line 37 is: $52,000 or less $52,001 – $105,000 $105,001 – $168,000 $168,001 – $233,000 $233,001 – $299,000 $299,001 or more Single Filers Enter $19 $25 $29 $35 $37 $59 Joint Filers Enter $38 $50 $58 $70 $74 $118 38. TABOR State Sales Tax Refund: For full-year Colorado residents, born before 2007, or full-year Colorado residents who are under the age of eighteen but are required to file a return. Your return must be postmarked or transmitted by the extension due date. Use the amount on line 37 and reference the table above 39. Sum of lines 33 and 38 40. Overpayment, if line 39 is greater than line 23 then subtract line 23 from line 39 41. Estimated Tax Credit Carryforward to the next tax year, if any 42. Refund, subtract line 41 from line 40. If you would like to donate all or a portion of your refund to a qualified Colorado charity, complete and submit form DR 0104CH with your return This page is required. 38 39 40 41 42 00 cents 00 cents 00 cents 00 cents 00 cents 34 35 36 37 00 cents 00 cents 00 cents 00 cents *250104==69999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 7 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) 43. Net Tax Due, subtract line 39 from line 23 44. Delinquent Payment Penalty (see instructions) 45. Delinquent Payment Interest (see instructions) 46. Estimated Tax Penalty, you must submit the DR 0204 with your return (see instructions) 47. Amount You Owe, sum of lines 43 through 46 The State may convert your check to a one-time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically. Direct Deposit Routing Number Account Number Type: Checking Savings CollegeInvest 529 For questions regarding CollegeInvest direct deposit or to open an account, visit CollegeInvest.org or call 800-448-2424. Third Party Designee Do you want to allow another person to discuss this return and any related information with the Colorado Department of Revenue? See the instructions. No Yes. Complete the following: Designee’s Name Phone Number This page is required. 43 44 45 46 47 00 cents 00 cents 00 cents 00 cents *250104==79999*

DR 0104 (10/03/25) COLORADO DEPARTMENT OF REVENUE Tax.Colorado.gov Page 8 of 8 Your Last Name (match page 1) Your First Name (match page 1) Your Middle Initial S S N or I T I N (match page 1) Sign Below Under penalties of perjury, I declare that to the best of my knowledge and belief, this return is true, correct, and complete. Your Signature Date (MM/DD/YY) Spouse’s Signature. If joint return, both must sign. Date (MM/DD/YY) Paid Preparer’s Name Paid Preparer’s Phone Paid Preparer’s Address City State ZIP Code File and Pay You may file and pay at: Colorado.gov/RevenueOnline or If you are mailing this return with a check or payment, please send all eight required pages to: Colorado Department of Revenue Denver, CO 80261-0006 If you are mailing this return without a check or payment, please send all eight required pages to: Colorado Department of Revenue Denver, CO 80261-0005 These ZIP codes are exclusive to the Colorado Department of Revenue, so a street address is not required. This page is required. *250104==89999*