Form 78-629a - Penalty Waiver Request - Iowa Department Of Revenue
Download a blank fillable Form 78-629a - Penalty Waiver Request - Iowa Department Of Revenue in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 78-629a - Penalty Waiver Request - Iowa Department Of Revenue with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Reset Form
Print Form
Iowa Department of Revenue
Penalty Waiver Request
(Sales, Retailers Use, Consumer’s Use, Withholding, Cigarette/Tobacco, & Motor Fuel)
LEGAL NAME
BUSINESS TRADE NAME
ADDRESS 1
CONTACT NAME FOR QUESTIONS
ADDRESS 2
DAYTIME PHONE NUMBER
CITY. STATE, ZIP
E-MAIL
.
Permit #: _________________________________________ Tax Period(s): __________________________________
Collection Account # (if you have been billed): ___________________________________________________________
Check which of the following penalty types you are asking to be waived (see instructions on page 2):
____ 10% Penalty for Failure to Timely File a Return (Penalty Type A)
____
5% Penalty for Failure to Timely Pay the Tax Due (Penalty Type B)
____
5% Penalty for Audit Deficiencies (Penalty Type C)
NOTE: The 75% Penalty for Willful Failure to File a Return cannot be waived
From the list of 13 penalty waiver reasons authorized by law, shown on page 2, give the number(s) of the waiver reason(s)
and why the reason(s) fits your situation. If none of the waiver reasons fit your case, the penalty cannot be waived.
Reason(s) for Waiver # _________
Describe below why the penalty waiver reason(s) you selected applies. If additional documentation is required
to prove your reason(s) for requesting a waiver, it must be attached or your waiver request will be denied.
________________________________________
_________________
Signature
Date
Submit this waiver request:
By e-Mail: Dennis.kyle@iowa.gov
(Fill out and save to your computer and submit as an e-mail
attachment. You must use the free Adobe Reader Version 11 to save a fillable form .)
By FAX: 515-281-0763
By Mail: Iowa Department of Revenue
Penalty Waiver
PO Box 10471
Des Moines, IA 50306-0471
78-629a (05/23/13)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial