
DR 1317 (07/19/13)
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0005
www.TaxColorado.com
Child Care Contribution
Organization Name
License Number or Colorado Account Number FEIN
Address Telephone Number
( )
City State Zip
Last Name of Preparer First Name Middle Initial
Signature of Preparer
Donor Last Name First Name Middle Initial SSN or Colorado Account Number
Address City State Zip
Credit Computation
Date of donation (MM/DD/YY)
1. Donation amount $
2. Non-qualifying donation $
3. Qualifying donation, line 1 minus line 2 $
4. Credit available, line 3 times 50% $
All functions of the donee organization qualify for the tax credit.
%
for all organization programs.
Other (describe allocation below)
Describe allocation
This form is to be completed by the donee organization,
then given to the donor. The donee organization should
retain completed copies for record keeping.
Donors shall submit this form with their Colorado income
tax return when claiming the child care contribution credit.
electronic return, upload a copy in Revenue Online or mail
with form DR 1778.
Social Security number may be completed by the donor
after receipt from the donee organization.
*131317==19999*