Form Ia 1120s - Iowa Income Tax Return For An S Corporation - 2006 Page 2

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Iowa Department of Revenue
Schedule of Partner or Shareholder Information
Part II Attach to IA 1065 or IA 1120S
NOTE: This form must be completed in full; preapproval required for any change
(2)
(5)
(1)
(3)
(6)
(4)
(7)
Partner’s / Shareholder’s Name
Resident/
Share of
Social Security No.
%
Non-
Net Modifications
Full Mailing Address
or
All-Source Income
Interest
Apportioned Income
Resident
City, State, Zip Code
Fed I.D. Number
%
%
%
%
%
%
%
%
41-034a
8/01/06

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