Form 35-002a - Iowa Contractor'S Statement
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1Iowa Contractor’s Statement
https://tax.iowa.gov
Contractor’s Name
Name of government unit, private nonprofit education institution, nonprofit
museum, business in economic development area, rural water district, or
Address
Habitat for Humanity
City________________________State__________ ZIP
Iowa Sales or Use Tax Permit Number (if any)
Address
SSN or FEIN
City________________________State___________ ZIP__
_
Project Description
If contract is not directly with the above name, who is your contract
Is your contract written? Yes ☐, No ☐ If yes, date signed
directly with?
/
/
INCLUDE ONLY BUILDING MATERIALS THAT BECOME PART OF REAL PROPERTY. See instructions on reverse side.
A
B
C
D
E
F
G
Name, Tax Period, and Iowa Permit Number Under Which
Name, City, and State of Material Supplier
Type of Building
Purchase
Amount of
Amount of
County
the Tax Was Remitted to the State of Iowa.
Material
Price
Iowa
Iowa Local
Number
Sales/Use Tax
Option
Where Iowa
Tax
Local Option
Was Paid
Total (provide the totals for columns C, D and F)
I, “Contractor”,
Subscribed and sworn to by
before me
state that his statement is
made pursuant to section 423.4, Code of Iowa, that all statements made herein,
on this
day of
20
are true and accurate to the best of my knowledge and belief; that all of the
Notary Public in and for
County
tangible personal property described herein became an integral part of the
project herein described, and sales or use tax was paid to Iowa as shown.
of Iowa.
Signature
Title
35-002a (06/30/16)
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