Form Ia 1120s - Iowa Income Tax Return For An S Corporation/schedule K-1 - Nonresident Shareholder Only/etc. - 2008 Page 3

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Iowa Department of Revenue
Schedule of Partner or Shareholder Information
Part II Attach to IA 1065 or IA 1120S
NOTE: This form must be completed in full; preapproval required for any change
(1)
(2)
(3)
(5)
(6)
(4)
(7)
Partner’s / Shareholder’s Name
Resident/
Share of
Social Security No.
%
Full Mailing Address
Non-
Net Modifications
or
Interest
All-Source Income
Apportioned Income
City, State, Zip Code
Resident
Fed I.D. Number
%
%
%
%
%
%
%
%
41-034a
8/01/06

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