Form Ia 1040es 2004 - Calendar Year Installment Due Date Page 2

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IA 1040ES 2004
Iowa Department of Revenue
I
2
FOR CALENDAR YEAR 2004 OR FISCAL YEAR ENDING ___________ , 20 _____
CALENDAR YEAR
INSTALLMENT DUE DATE
Your Social Security Number
JUNE 30, 2004
Daytime Telephone Number
AMOUNT OF PAYMENT $ _____________________
(
)
-
Mail to:
Estimate Processing
Iowa Department of Revenue
PO Box 10466
Make check or money order payable to: "Treasurer - State of Iowa"
45-002 (6/9/03)
Des Moines, IA 50306-0466
Or pay online at
IA 1040ES 2004
Iowa Department of Revenue
I
1
FOR CALENDAR YEAR 2004 OR FISCAL YEAR ENDING ___________ ,20 _____
CALENDAR YEAR
INSTALLMENT DUE DATE
Your Social Security Number
APRIL 30, 2004
Daytime Telephone Number
AMOUNT OF PAYMENT $ _____________________
(
)
-
Mail to:
Estimate Processing
Iowa Department of Revenue
PO Box 10466
Make check or money order payable to: "Treasurer - State of Iowa"
45-002 (6/9/03)
Des Moines, IA 50306-0466
Or pay online at
2004
Nonresident Request for Release From Withholding
For calendar year 2004 or fiscal year beginning ________________ , 20 _______ and ending _______________ , 20 ________
Social Security Number
Daytime Telephone Number
Name
Zip Code
City
State
Number and Street or Rural
Route
Income from Iowa source(s).
Name and Address of Payer
Gross Income
Related Expenses
Net Income
a)
a) ___________________________________________________________________________________________________________________________________________
b)
b) ___________________________________________________________________________________________________________________________________________
Total Estimated Iowa Net Income - add net income on lines a and b.
Submit this form along with tax payments and installment coupon.
(6/9/03)

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