OFFICE USE ONLY
Iowa Department of Revenue
2009 IA 1120S
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Iowa Income Tax Return for an S Corporation
From____/____/____to____/____/____
Check the box if this is
(1) Name/Address Change
(2) A Short Period
Corporation Name and Address
Box A
Box B
FEIN.:
Business Code:
Box C
County No.:
Is this a first or final return? If yes, check the appropriate box.
First Return
New Business
Successor
Entering Iowa
Final Return
Reorganized
Merged
Dissolved
Name of contact person: _____________________________
Phone No.: ( _____ ) _________ - _________ Ext: _______
Withdrawn
Bankruptcy
Others__________
Type of Return:
1 S Corporation
2 IC Domestic International Sales Corporation
3 Foreign Sales Corporation
Is this an inactive corporation? .................................................
Yes
No
Was federal income or tax changed for any prior period(s)? ...
Yes
No Periods_____________________________
Is the corporation’s business carried on entirely within Iowa? .
Yes
No
Date of S corporation election: _____________
SCHEDULE S
USE WHOLE DOLLARS
1. Net income per federal Schedule K. See instructions. ............................................................................................... 1 __________________
2. Interest and dividends exempt from federal income tax. See instructions. ..................... 2 _________________
3. Other additions. Attach schedule. ..................................................................................... 3 _________________
4. Total additions. Add lines 2 and 3. .................................................................................................................................. 4 __________________
5. 50% of federal income tax ................................................................................................. 5 _________________
6. Interest and dividends from f eder al securities. See instructions. .................................... 6 _________________
7. Other reductions. Attach schedule. ................................................................................... 7 _________________
8. Total reductions. Add lines 5, 6, and 7. ........................................................................................................................... 8 __________________
9. Net modifications. Subtract line 8 from line 4. ................................................................................................................ 9 __________________
10. Modified federal net income. Add line 1 and line 9. ....................................................................................................... 10 __________________
SCHEDULE K
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Name and Address of Shareholder
Resident/ Social Security No.
%
Share of
All-Source
Apportioned
Nonresident or Federal I.D. No.
Interest
Modifications
Income
Income
A.
%
B.
%
C.
%
D.
%
E.
%
F.
%
Check if additional shareholders. Complete schedule
TOTALS
100%
41-034 from our Web site, and attach.
11. Tax on built-in gains or passive investment income. See instructions. .......................................................................... 11 __________________
Make check payable to Treasurer-State of Iowa
Information from Prior Period Iowa Return: Corporation Name ______________________________________________________________
Net Income/(Loss) $ ___________________________
FEIN: _________________________________________________
A complete copy of your federal return, as filed with the Internal Revenue Service, MUST be filed with this return.
Under penalties of perjury, I declare that I have examined this return and any attached schedules/statements, and, to the best of my knowledge, believe it to
be true, correct and complete. If prepared by a person other than the taxpayer, the declaration is based on all information of which there is any knowledge.
Officer’s Signature: ______________________________________________________
Date: _______ Title: _______________________
Preparer’s Signature: ____________________________________________________
Date: _______
Preparer’s Address: ______________________________________________________ Preparer’s ID No.: ____________________________
Mail to: Corporate Tax Return Processing, Iowa Department of Revenue, P.O. Box 10468, Des Moines IA 50306-0468
42-004a (06/03/09)