Form Ia 1139 - Application For Refund Due To The Carryback Of Losses - 2008
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1
2Iowa Department of Revenue
IA 1139
Application for Refund Due to the Carryback of Losses
Do not attach to Iowa return; mail in separate envelope.
Corporation Name and Address
Federal T.I.N.
Type of Tax
Corporation
Franchise
Loss Return for the period ended ____/____/____
Remaining to be carried forward
Net Operating $ ______________________
$ ________________________
Capital
$ ______________________
$ ________________________
federal
Check box if name, address, or
Altr. Min. Tax $ ______________________
$ ________________________
TIN has changed.
Federal Audit Involved
YES
NO
Phone No. (_____)______-____________
Disaster Area
Capital Loss
2nd preceding
1st preceding
NOTE: The 3rd preceding year
3rd preceding
tax period____/____/____
tax period____/____/____
tax period____/____/____
is used for losses in a
Presidentially declared Disaster
after carryback
as last reported
after carryback
as last reported
after carryback
as last reported
on ________
on ________
on ________
Area or for a Capital Loss
1. Net Income .......................................
____________________________________________________________________________________________________________
2. Iowa Capital Loss ..............................
____________________________________________________________________________________________________________
3. Capital Loss Subtotal (line 1 minus 2)
____________________________________________________________________________________________________________
4. 50% Federal Refund From Capital Loss
____________________________________________________________________________________________________________
5. Subtotal (Add lines 3 and 4) ...............
____________________________________________________________________________________________________________
6. Nonbusiness Income .........................
____________________________________________________________________________________________________________
7. Income Subject To Apportionment
____________________________________________________________________________________________________________
8. Iowa Percentage ...............................
____________________________________________________________________________________________________________
9. Income Apportioned To Iowa .............
____________________________________________________________________________________________________________
10. Iowa Nonbusiness Income ...............
____________________________________________________________________________________________________________
11. Income Before Net Operating Losses
____________________________________________________________________________________________________________
12. Iowa Net Operating Loss Carryforward
____________________________________________________________________________________________________________
13. Iowa Net Operating Loss Carryback
____________________________________________________________________________________________________________
14. Income Subject To Tax ...................
____________________________________________________________________________________________________________
15. Computed Tax ................................
____________________________________________________________________________________________________________
16. Minimum Tax (attach forms) ............
____________________________________________________________________________________________________________
17. Total Tax Liability ............................
____________________________________________________________________________________________________________
18. Recomputed Tax Liability (line 17)
____________________________________________________________________________________________________________
19. Decrease In Tax (line 17 minus 18)
____________________________________________________________________________________________________________
Under penalties of perjury, I declare that I have examined this return, and attached schedules/statements, and, to the best of my
knowledge, believe it to be true, correct and complete. If prepared by a person other than the taxpayer, the declaration is based
on all information of which there is any knowledge.
Officer’s Signature _______________________________________ Date _________
Title __________________________________
Preparer’s Signature ______________________________________ Date _________
Preparer’s Phone _______________________
Preparer’s ID No. _______________________
You must attach a copy of page one of the company’s Iowa
returns as filed and any federal forms 1120X or 1139 filed for all
periods involved with this claim.
Interest on claim will accrue starting on the date all required information is received by the Department.
42-026a
(8/20/08)
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