Form 92-033 - Request For Change, Correction, Cancellation Of Tax Permit
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Request for Change, Correction,
Submit your permit
Iowa Department of Revenue
information changes online!
or Cancellation of Tax Permit
Go to:
Mail This Form To:
Legal Name: __________________________________________________________
Registration Services
Trade Name: __________________________________________________________
Iowa Department of Revenue
P.O. Box 10465
Mailing Address: _______________________________________________________
Des Moines, IA 50306-0465
Fax: 515-281-3906
City:
State:
ZIP:
Indicate by checkmark and permit number those permit records you request to change, correct, or cancel.
Sales Tax Permit
No. ___________________________________
Motor Fuel Tax Permit
No. ___________________________________
Consumer's Use Tax Permit
No. ___________________________________
Retailer's Use Tax Permit
No. ___________________________________
Household Hazardous Material Permit
No. ___________________________________
Employer Withholding Permit
No. ___________________________________
Other
No. ___________________________________
Checkmark and complete the applicable area(s):
Cancel. Reason: _________________________________________________ Effective date: _____________________
Reinstate. Reason: _______________________________________________ Effective date: _____________________
Name Change
Change legal name to: __________________________ New Federal Identification Number: _____________________
Change trade name to: ______________________________________________________________
Address Change
Change mailing address only to: _______________________________________________________________________
__________________________________________________________________________________________________
Change physical location address only to (PO Box Not Allowed): ___________________________________________
__________________________________________________________________________________________________
Change physical location and mailing address to: _________________________________________________________
__________________________________________________________________________________________________
Officers and Partners
Add corporate officer name: __________________________________________________________
Address: ________________________________________________________ Soc. Sec. No. ______________________
Delete corporate officer name: ______________________________________ Soc. Sec. No. ______________________
Add partner name: __________________________________________________________________
Address: ________________________________________________________ Soc. Sec. No. ______________________
Delete partner name: ______________________________________________ Soc. Sec. No. ______________________
Filing Frequency (if qualified)
Change of filing frequency (effective the 1st day of the next quarter): ________________________
Change to annual filer only during January and February. (Requests received after last day of February will become
effective the 1st day of the following year.)
Other
Corrections: ________________________________________________________________________________
Request for copy of Sales Tax Permit
(A letter with your Business eFile Number (BEN), your permit number, and a printed permit.)
Owner / Officer Signature:__________________________________________Date: ________________
Title: _____________________________________________
Contact Person: _______________________________ Contact Phone Number: ______________________
Questions?
You will also need to complete a new permit application form if you are changing:
• ownership, incorporating, type of ownership, Federal Identification Number
idr@iowa.gov
• location address from one Iowa county to another and have a sales tax or consumer’s use tax permit
1-800-367-3388
• physical location address from Iowa to out of state
or 515-281-3114
• physical location address from out of state to Iowa
92-033 (01/30/12)
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Parent category: Financial