Form Ia 1040a - Iowa Individual Income Tax Short Form

Form Ia 1040a - Iowa Individual Income Tax Short Form - 2008 Page 2

IA 1040A Schedule B

Iowa Department of Revenue

Interest and Dividend Income

Name(s) as shown on page 1 of the IA 1040A

Social Security Number

Note: You must report all taxable interest and dividends on IA 1040A, even if you are not required to complete Schedule B.

You must complete Part I if you received more than $1,500 in interest in the tax year. Interest income

PART I:

which should be reported includes earnings from savings and loan associations, mutual savings banks,

cooperative banks, credit unions, and bank deposits; State and municipal bonds, and interest from tax

INTEREST

refunds. Do not report interest from federal securities.

INCOME

Interest Income. List Names of All Payers.

Name of Payer

AMOUNT

.00

Total Taxable Interest Income.

Add the amounts; enter here and on IA 1040A, line 2. .......................................................................

.00

PART II:

You must complete Part II if you received more than $1,500 in gross dividends in the tax year. Deduct

that portion of any net dividend from mutual funds that is attributable to federal securities.

DIVIDEND

Dividend Income. List Names of All Payers.

INCOME

Name of Payer

AMOUNT

.00

Total Taxable Dividend Income.

Add the amounts; enter here and on IA 1040A, line 3. .......................................................................

.00

41-080b (8/14/08)

Form Ia 1040a - Iowa Individual Income Tax Short Form - 2008 Page 2