Form 44-095a - Withholding Quarterly Return

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Line-by-line Instructions for Completing Withholding Quarterly Return
Due Date:
Line 1:
Line 2:
Line 3:
Line 4:
Line 5:
Line 6:
Line 7:
Penalty for Failure to Timely File a Return or Deposit:
Penalty for Failure to Timely Pay the Tax Due or Penalty for Audit Deficiency:
If both penalties apply, only the failure to file penalty is charged.
Interest:
Signature of Withholding Agent:
Mail To:
u Withholding Tax Guide:
u Web Site:
u E-mail:
u Tax Fax:
u Telephone:
u Questions?
u E-mail:
u Call:
u Recorded Information:
DETACH HERE
Iowa Department of Revenue
Withholding Quarterly Return
1. Total Tax
Withheld
This Quarter
2. This Quarter’s
Monthly
Deposits
3. Less
s
s
Employer ID Number
Period Ending
Adjustments/
Credits
4. Balance Due
Due Date
Subtract lines 2
and 3 from line 1.
5. Penalty
Name and Address
s
6. Interest
s
7. Amount Due
s
MAKE CHECK PAYABLE TO
Signature of Withholding Agent ___________________________ Date _________
TREASURER - STATE OF IOWA
Daytime Phone No.: ______________________
44-095a (9/16/03)

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