Questionnaire 21-004: Activities Within Iowa For A Corporation, Partnership Or Llc

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Questionnaire 21-004: Activities Within Iowa
Iowa Department of Revenue
For a Corporation, Partnership or LLC
Enter the reference number from our letter here:______________________
It is important that you sign the last page of the questionnaire.
Please provide a detailed explanation when requested. If more room is needed, attach a separate page.
1. Exact corporation, business or trade name and address of principal office if different from our letter:
2. Date of Original Formation: (Mo/Yr) ___________ State of Incorporation (Mo/Yr) ___________
3. Taxpayer Identification Number (TIN) also known as the Federal Employer Identification Number
(FEIN) from your Federal Income Tax return.______________________________
4. Business Activity Code, NAICS, from your Federal Income Tax return. It can be found in “Additional
Information” area of the return by Schedule J (Tax Computation). _____________________________
5. Have you ever had an election as an S Corp.? Yes ____ No ____
If YES, for what periods? ______________________________________________________________
6. If you have ever filed returns with this Department, please complete the following:
Yes/No
Periods
TIN/Permit #
Corporation Income Tax?
_____
__________________
___________________
Sales/Use Tax?
_____
__________________
___________________
Withholding Tax?
_____
__________________
___________________
Motor Fuel Tax?
_____
__________________
___________________
7. If an affiliated company does or did file an Iowa return, please complete the following:
Yes/No
Periods
TIN/Permit #
Corporation Income Tax?
_____
__________________
___________________
Sales/Use Tax?
_____
__________________
___________________
Withholding Tax?
_____
__________________
___________________
Motor Fuel Tax?
_____
__________________
___________________
8. If you are included in a consolidated Federal return, please provide the name, address and FEIN or TIN
used on that return: ____________________________________
9. Describe your business in detail (including copies of all sales brochures and other documents pertaining
to your products made available to your customers):
21-004a (04/04/11)

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