Form 70-020a - Roll Your Own Report Of Purchases Form Nonparticipating Manufacturers

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Roll Your Own Report of Purchases from
Nonparticipating Manufacturers
State of Iowa
Due January 31, 2001
This report is for the period of January 1, 2000 through December 31, 2000.
Step 1:
Distributor information
Step 2:
Nonparticipating manufacturer information
Number of ounces
sold Iowa tax paid
1 ___________________________
____________________________________
__________
_____________
2 ___________________________
____________________________________
__________
_____________
3 ___________________________
____________________________________
__________
_____________
4 ___________________________
____________________________________
__________
_____________
5 ___________________________
____________________________________
__________
_____________
6 ___________________________
____________________________________
__________
_____________
7 ___________________________
____________________________________
__________
_____________
8 ___________________________
____________________________________
__________
_____________
Where do I send my completed report?
Distributor Signature: ________________________ Date: _________
IOWA

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