Form 31-004 Rf10b - Iowa Sales Tax Quarterly Return

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Information Form
Use this form to report address and name changes, cancel your permit, change
your filing frequency, or request information on Electronic Funds Transfer (EFT).
Permit number
Enter weekday phone number
Location name and address
Mailing name and address
If different than above:
If different than above:
Correct location name and address:
Correct mailing name and address:
Send this form to:
Registration Services
PO Box 10465
Des Moines IA 50306-0465.
IMPORTANT: You must file even if you had no sales tax activity during
SALES TAX QUARTERLY RETURN
IOWA
the quarter.If you had no sales, put zeroes on lines 1 and 12.
31-004 rf10a 11/19/01
s
1 Gross Sales (quarter)
s
2 Goods Consumed (quarter)
3 Total (add lines 1 and 2)
s
4 Exemptions (from line 21) (quarter)
5 Taxable Amount (line 3 minus line 4)
s
s
Permit
Period
Date Due
s
6a State Sales Tax (5% of line 5) (quarter)
s
Check box if sales are
6b Total Local Option Sales Tax (quarter)
made only in county
s
your business is located.
6c Total School Local Option Tax (quarter)
7 Total Tax (add lines 6a, 6b, and 6c)
s
8 Deposits and Overpayment Credits
9 Balance (line 7 minus line 8)
s
10 Penalty (if applicable)
s
11 Interest (if applicable, see instructions)
Title
Signature of Retailer or Agent
Date
s
12 Total Amount Due (add lines 9-11)
Daytime Phone No.: ________________
IMPORTANT: You must file even if you had no sales tax activity during
SALES TAX QUARTERLY RETURN
IOWA
the quarter.If you had no sales, put zeroes on lines 1 and 12.
31-004 rf10a 11/19/01
s
1 Gross Sales (quarter)
s
2 Goods Consumed (quarter)
3 Total (add lines 1 and 2)
s
4 Exemptions (from line 21) (quarter)
5 Taxable Amount (line 3 minus line 4)
s
s
Permit
Period
Date Due
s
6a State Sales Tax (5% of line 5) (quarter)
s
Check box if sales are
6b Total Local Option Sales Tax (quarter)
made only in county
s
your business is located.
6c Total School Local Option Tax (quarter)
7 Total Tax (add lines 6a, 6b, and 6c)
s
8 Deposits and Overpayment Credits
9 Balance (line 7 minus line 8)
s
10 Penalty (if applicable)
s
11 Interest (if applicable, see instructions)
Title
Signature of Retailer or Agent
Date
s
12 Total Amount Due (add lines 9-11)
Daytime Phone No.: ________________

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