Form - Ia 843 - Claim For Refund - Iowa Department Of Revenue - 2013 Page 2
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1
2Computation of Local Option Sales Tax
Claim Period
to
Break down the claim period by quarters. Attach an additional sheet if needed. Break down each tax period by county. Enter the
local option tax to be refunded on the front of this claim on line 2, Subtotal Local Option Sales Tax Refund.
TAX
COUNTY
ORIGINAL
CORRECTED
LOCAL OPTION SALES TAX
PERIOD
NUMBER
TAX PAID
AMOUNT
TO BE REFUNDED
TOTALS
Enter on line 2 of page 1, Subtotal
Instructions for IA 843
If this is a correction to a sales tax return, you need to file an amended return.
Who May File
Farm and Processing Machinery and Equipment: Provide
Any taxpayer who believes that an overpayment of retail sales,
copies of the invoices. Explain how each item is used directly
retailer’s use, consumer’s use, vehicle one-time registration
and primarily in agricultural production or in processing.
fee, local option sales, local hotel/motel, automobile rental,
Computers: Provide copies of all invoices. Explain how they
or state excise tax exists may file this Claim for Refund form.
are used in processing or storing data and describe your type
The IA 843 may not be used to claim a refund of withholding.
of business or occupation.
Employers must file an amended withholding quarterly return to
Vehicle One-time Registration Fee (on or after 7-1-08):
claim a withholding tax refund.
Provide copies of the original bill of sale, the title, and any
Individuals must file the IA 1040 or IA 1040X, as appropriate,
additional supporting information. NOTE: The vehicle
to request a refund of Iowa income tax withheld.
identification number (VIN) must be entered on the first page
All claims must include a sales or use tax permit number, if
of this claim form.
applicable.
Local Option Sales Tax: Provide copies of all invoices
Individuals: You must provide your Social Security Number.
verifying that local option sales tax has been paid to the State
Sole Proprietors: You must provide a Social Security Number
of Iowa.
and a Federal Employer Identification Number, if applicable.
Biodiesel Production: Provide the number of biodiesel
Partnerships and Corporations: You must provide your
gallons produced during each quarter.
Federal Employer Identification Number.
Where is My Sales/Use Refund? Call 515-242-6034.
Who Must Sign
Questions?
If a claim is filed for a corporation, the claim must be signed
·
Phone: 515-281-3114 or 1-800-367-3388
either by an officer or other authorized representative of the
·
eMail: idr@iowa.gov
corporation. If an attorney or agent is filing the claim on behalf
Where to File: Compliance Services
of the claimant, a power of attorney (original) authorizing the
Iowa Department of Revenue
attorney or agent to sign must be submitted with the claim. A
PO Box 10456, Des Moines, IA 50306-0456
power of attorney should clearly identify who is to receive the
refund check and where it should be mailed.
IOWA COUNTIES AND COUNTY NUMBERS
Supporting Documentation Required - contact the
01-ADAIR
26-DAVIS
51-JEFFERSON
76-POCAHONTAS
Department if you would like to submit supporting
02-ADAMS
27-DECATUR
52-JOHNSON
77-POLK
03-ALLAMAKEE
28-DELAWARE
53-JONES
78-POTTAWATTAMIE
documentation electronically.
04-APPANOOSE
29-DES MOINES
54-KEOKUK
79-POWESHIEK
05-AUDUBON
30-DICKINSON
55-KOSSUTH
80-RINGGOLD
06-BENTON
31-DUBUQUE
56-LEE
81-SAC
Retail Sales/Use Tax, Consumer’s Use Tax, Local Hotel/
07-BLACK HAWK
32-EMMET
57-LINN
82-SCOTT
08-BOONE
33-FAYETTE
58-LOUISA
83-SHELBY
Motel, State Excise, and Automobile Rental Tax: Provide
09-BREMER
34-FLOYD
59-LUCAS
84-SIOUX
10-BUCHANAN
35-FRANKLIN
60-LYON
85-STORY
copies of the invoices, exemption certificates, credit memos,
11-BUENA VISTA
36-FREMONT
61-MADISON
86-TAMA
12-BUTLER
37-GREENE
62-MAHASKA
87-TAYLOR
and any other supporting documentation applicable.
13-CALHOUN
38-GRUNDY
63-MARION
88-UNION
14-CARROLL
39-GUTHRIE
64-MARSHALL
89-VAN BUREN
Fuel Used in Processing and Implements of Husbandry: A
15-CASS
40-HAMILTON
65-MILLS
90-WAPELLO
16-CEDAR
41-HANCOCK
66-MITCHELL
91-WARREN
processing vs. nonprocessing energy study to determine the
17-CERRO GORDO
42-HARDIN
67-MONONA
92-WASHINGTON
18-CHEROKEE
43-HARRISON
68-MONROE
93-WAYNE
exempt percentage, copies of all invoices, and a schedule of
19-CHICKASAW
44-HENRY
69-MONTGOMERY
94-WEBSTER
20-CLARKE
45-HOWARD
70-MUSCATINE
95-WINNEBAGO
energy used. Explain how the equipment using the fuel is used
21-CLAY
46-HUMBOLDT
71-O’BRIEN
96-WINNESHIEK
22-CLAYTON
47-IDA
72-OSCEOLA
97-WOODBURY
in this processing, and describe the tangible personal property
23-CLINTON
48-IOWA
73-PAGE
98-WORTH
24-CRAWFORD
49-JACKSON
74-PALO ALTO
99-WRIGHT
to be sold at retail.
25-DALLAS
50-JASPER
75-PLYMOUTH
22-009b (09/11/13)
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