Form DR6596 "Statement of Income and Expenses" - Colorado

What Is Form DR6596?

This is a legal form that was released by the Colorado Department of Revenue - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 20, 2017;
  • The latest edition provided by the Colorado Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DR6596 by clicking the link below or browse more documents and templates provided by the Colorado Department of Revenue.

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Download Form DR6596 "Statement of Income and Expenses" - Colorado

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DR 6596 (06/20/17)
*136596==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0004
(303) 205-8291
Statement of Income and Expenses
The Department of Revenue uses this form to obtain your current financial information, and to determine how you are best
suited to pay your outstanding tax liability. Be sure to write clearly and do not leave any area blank.
If additional space is needed, please attach a separate sheet that includes your name, social security number and clearly
classify the additional information according to the areas below.
Account Number, if known
Date
(MM/DD/YY)
Taxpayer Information
Taxpayer Name
SSN
DOB
Spouse Name
SSN
DOB
Address
City
State
ZIP
Daytime Phone
Email
Age and relationship of people living with you (dependents only):
Employer Information
Current Employer - Taxpayer
Phone
Employer Address
City
State
ZIP
Length of Employment
Pay Cycle
Net Pay (after taxes)
(monthly, biweekly, weekly)
Current Employer - Spouse
Phone
Employer Address
City
State
ZIP
Length of Employment
Pay Cycle
Net Pay (after taxes)
(monthly, biweekly, weekly)
Non-Wage Household Income - list monthly amounts for the entire household
$
$
Profit from business
Unemployment Income
$
$
Commissions
Interest/Dividends
$
$
Pension/Social Security Income
Net Rental Income
$
$
Alimony/Child Support Income
Other Income
TOTAL INCOME
$
- enter the sum of all household income
Accounts
- include checking, online/mobile (PayPal, etc.), savings, loans, CD, credit union, etc.
Name of Institution
Address
Account Number
Current Balance
$
$
Securities
- include stocks, bonds, annuities, mutual funds, IRA, money market funds, whole life insurance policies, etc.
Type
Issuer
Quantity/Denomination
Current Value
$
$
Please complete reverse side of form
DR 6596 (06/20/17)
*136596==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0004
(303) 205-8291
Statement of Income and Expenses
The Department of Revenue uses this form to obtain your current financial information, and to determine how you are best
suited to pay your outstanding tax liability. Be sure to write clearly and do not leave any area blank.
If additional space is needed, please attach a separate sheet that includes your name, social security number and clearly
classify the additional information according to the areas below.
Account Number, if known
Date
(MM/DD/YY)
Taxpayer Information
Taxpayer Name
SSN
DOB
Spouse Name
SSN
DOB
Address
City
State
ZIP
Daytime Phone
Email
Age and relationship of people living with you (dependents only):
Employer Information
Current Employer - Taxpayer
Phone
Employer Address
City
State
ZIP
Length of Employment
Pay Cycle
Net Pay (after taxes)
(monthly, biweekly, weekly)
Current Employer - Spouse
Phone
Employer Address
City
State
ZIP
Length of Employment
Pay Cycle
Net Pay (after taxes)
(monthly, biweekly, weekly)
Non-Wage Household Income - list monthly amounts for the entire household
$
$
Profit from business
Unemployment Income
$
$
Commissions
Interest/Dividends
$
$
Pension/Social Security Income
Net Rental Income
$
$
Alimony/Child Support Income
Other Income
TOTAL INCOME
$
- enter the sum of all household income
Accounts
- include checking, online/mobile (PayPal, etc.), savings, loans, CD, credit union, etc.
Name of Institution
Address
Account Number
Current Balance
$
$
Securities
- include stocks, bonds, annuities, mutual funds, IRA, money market funds, whole life insurance policies, etc.
Type
Issuer
Quantity/Denomination
Current Value
$
$
Please complete reverse side of form
DR 6596 (06/20/17)
*136596==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0004
(303) 205-8291
Taxpayer Name
Account Number, if known
Real Estate
- include home, vacation, timeshares, rental properties, etc.
Description/Location/County
Mortgage Company
Current Value
Balance Owed
$
Primary residence? Y / N
$
Primary residence? Y / N
Motor Vehicles
- include cars, boats, recreation vehicles, etc.
Year/Make/Model/License Plate
Financing Company
Current Value
Balance Owed
$
$
Monthly Necessary Living Expenses
Enter the monthly amount of your expenses. For any expenses not paid monthly, convert as follows:
Quarterly bills: divide by 3
Weekly bills: multiply by 4.3
Biweekly bills: multiply by 2.17
Expenses should be reasonable for the size of your household. Substantiation may be required for any expenses over a reasonable amount.
$
$
Rent or mortgage payment
Telephone, cable, internet, cellphone
$
$
Child support and/or alimony paid
Transportation (gas, parking, bus fare, etc.)
$
$
Child/Dependent care
Out-of-pocket medical
$
$
Food and housekeeping supplies
Health insurance premiums
$
$
Clothing
Life insurance premiums
$
$
Personal care products and services
Automobile insurance
$
$
Gas/Electric
Homeowners or renters insurance
$
$
Water/Sewer
Car loan payment
Credit Cards - include lender name and account numbers
$
$
$
$
TOTAL EXPENSES
$
- enter the sum of all household expenses
Additional information - describe any expected changes to your income, expenses or employment below.
Under penalty of purjury, I declare to the best of my knowledge and belief this statement of assets, liabilities and other information is true, correct and complete.
Spouse signature
Taxpayer signature
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