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 10470
Mailing Address: _______________________________________________________
Des Moines, IA 50306-0470
Fax: 515-281-3906
City:
State:
ZIP:
Provide your permit number for those permits you request to change, correct, or cancel.
Sales Tax Permit Number:
Motor Fuel Tax Permit Number:
Consumer's Use Tax Permit Number:
Retailer's Use Tax Permit Number:
Household Hazardous Material Permit Number:
Employer Withholding Permit Number:
Other Permit Number:
Checkmark and complete the applicable area(s):
Cancel. Reason: __________________________________________________ Last date of activity for permit: ________
Reinstate. Reason: ________________________________________________ First date of activity for permit: ________
Name Change (if your legal name change is due to a change of ownership, you must cancel your permit and apply for a new one.):
Change legal name to: ___________________________ Federal Employer ID Number: ___________________________
Change trade name to: _______________________________________________________________
Address Change:
You need to cancel your permit(s) and complete a new application form if you are changing:
• location address from one Iowa county to another and have a sales tax or consumer’s use tax permit
• physical location address from Iowa to out of state
• physical location address from out of state to Iowa
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
(attach a separate list, if needed):
Add corporate officer name:
Effective Date:
Address:
SSN:
Inactive corporate officer name:
Effective Date:
SSN: ________________
Add partner name: _______________________________________________________ Effective date:
Address: ________________________________________________________ SSN: ____________________________
Inactive partner name:
Effective Date:
SSN:
Filing Frequency
(if qualified):
Change filing frequency to:
Quarterly
Monthly
Semi-monthly
January 1
April 1
July 1
October 1
Effective:
Change to annual filer effective January 1
(Requests received after April 30 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
Questions?
a printed permit.)
Owner / Officer Signature:__________________________________________Date: ___________________
idr@iowa.gov
Title:_________________________________________ Contact eMail:_______________________________
1-800-367-3388
Contact Person: _______________________________ Contact Phone Number:________________________
or 515-281-3114

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