Form 22-020a - Iowa Tax Amnesty Application - 2007 Page 2

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Iowa Tax Amnesty
September 4 through October 31, 2007
Eligible taxpayers include those who:
Iowa Tax Amnesty Application Instructions
did not file a required return;
Part I: Reason for Requesting Tax Amnesty
misreported, understated or omitted any tax
Check the appropriate box to indicate the reason
liability on a previously-filed return;
you are requesting Iowa Tax Amnesty.
erroneously claimed credits or deductions; or
have a current accounts receivable liability.
Part II: Taxpayer Information
For tax owed by an individual: Provide your
The following are not eligible:
name, address, Social Security Number, county you
Iowa Tax Amnesty will not be granted to a
currently live in, daytime telephone number(s) and
taxpayer who is the subject of an active criminal
e-mail address that may be used to contact you.
investigation or who is a party to a criminal
For tax owed by a business, corporation, or
proceeding that is pending in any of the court
other organization: Provide the name of the entity,
systems.
Federal Employer Identification Number of the
Eligible tax periods:
entity and/or name(s) and Social Security Number of
Iowa Tax Amnesty applies to all tax periods for
owner(s), address, permit number (if applicable),
which the original tax return was due on or prior to
county in which the business is currently located,
December 31, 2006.
daytime telephone number(s) and e-mail address that
may be used to contact you.
Eligible tax types:
Individual income
Part III: Tax Information
Corporation income
In the first column, enter the type(s) of tax for
Withholding
which you are requesting Iowa Tax Amnesty.
Sales and use
In the second column, enter the ending date of the
Fiduciary
tax period(s) for which you are applying for Iowa
Franchise
Tax Amnesty. List each period individually and
Local option sales taxes (regular local option and
attach additional sheets if necessary.
school local option)
In the third column, enter the total amount due for
Hotel / motel
that period. Add the amounts due for all periods and
Automobile rental
enter that on the Total Amount Due line.
Inheritance
The Total Amount Due means the total tax due
Motor fuel and special fuel
plus 50% of the interest due. Enclose with the
Environmental protection charge (EPC)
application the completed returns, or accounts
Cigarette and tobacco
receivable statement, and all payments.
Drug stamp
Part IV: Signature
Return and payment requirements:
Please sign and date the application. If you are
Pay all tax liabilities due the State of Iowa and
requesting Iowa Tax Amnesty on a jointly-filed
delinquent as of December 31, 2006
return, your spouse must also sign the application.
Pay full amount of tax due, and
Failure to sign the application will result in your
Pay one-half of interest due on or before
request for Iowa Tax Amnesty being denied.
October 31, 2007.
Mail To:
Do not pay penalties.
Enclose the completed application, return(s) and/
Make checks payable to Treasurer, State of Iowa.
or accounts receivable statement with the payment
For more information:
due and send to:
Iowa Tax Amnesty
or call the Iowa Department of Revenue:
PO Box 1792
1-877-4BAKTAX (1-877-422-5829) toll free
Des Moines IA 50306
22-020b (7/10/07)

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