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DR 0084 - Substitute Colorado W-2 Form

Substitute Colorado W-2 Form for Income Tax Withheld. Give reason why Form W-2, or the Statement of Corrected Income and Tax Amounts was not furnished by your employer (or the payer), if known. Explain your efforts to obtain the required information.

NOTE: If taxpayer was employed by more than one employer, a separate statement covering each employment and the amount of tax withheld must be filed.