Form Ia 843 - Claim For Refund (Page 2 of 2) in pdf

Computation of Local Option Sales Tax

Claim Period _______ to ________

Break down the claim period by quarters. Attach an additional sheet if needed. Please break down each tax period by county and each

type of local option sales tax. Combine the total of each type local option tax on the Total Combined line. Then record the

information on the front of this claim on line 2: Subtotals: Combine School and Regular Local Option Tax Refund.

School Local Option

TAX

COUNTY

ORIGINAL

CORRECTED

LOCAL OPTION TAX

Tax to be Refunded

PERIOD

NUMBER

TAX PAID

AMOUNT

TO BE REFUNDED

(for period prior to

7-1-08 only)

TOTALS

Total Combined Local Option Tax Due. Enter on line 2 of the first page of the IA 843.

Instructions for IA 843

*If this is a correction to a sales tax return, you need to file an amended return.

Who May File

Farm and Industrial Machinery and Equipment: Copies of

the invoices. Explain how each item is used directly and

Any taxpayer who believes that an overpayment of retail sales,

primarily in your agricultural production or manufacturing

retailer’s use, consumer’s use, vehicle one-time registration fee/

process.

use tax, local option, local hotel/motel, automobile rental, or

state excise tax exists may file this Claim for Refund form.

Computers: Copies of all invoices. Explain how they are used

in processing or storing data and explain your type of business

The IA 843 may not be used to claim a refund of withholding.

or occupation.

Employers must file an amended withholding quarterly return to

claim a withholding tax refund.

Vehicle One-time Registration Fee (on or after 7-1-08) /

Vehicle Use Tax (prior to 7-1-08): Copies of the original bill

Individuals must file the IA 1040, IA 1040A or IA 1040X, as

of sale, the title, and any additional supporting information.

appropriate, to request a refund of Iowa income tax withheld.

NOTE: The vehicle identification number (VIN) must be

All claims must include a sales or use tax permit number, if

entered on the first page of this claim form.

applicable.

Local Option Tax: Copies of the invoices and verification that

Individuals: You must provide your Social Security Number.

local option tax has been paid to the State of Iowa.

Sole Proprietors: You must provide a Social Security Number

Where to File: Compliance Division

and a Federal Employer Identification Number, if applicable.

Iowa Department of Revenue

Partnerships and Corporations: You must provide your

PO Box 10456

Federal Employer Identification Number.

Des Moines, IA 50306-0456

Who Must Sign

Where is My Sales/Use Refund? Call 515/281-8237.

If a claim is filed for a corporation, the claim must be signed

Other Assistance

either by an officer or other authorized representative of the

1-800-367-3388 (Iowa, Omaha, Rock Island, Moline) or

corporation. If an attorney or agent is filing the claim on behalf

515-281-3114 — 9 a.m. - 4 p.m., Monday through Friday

of the claimant, a power of attorney (original) authorizing the

attorney or agent to sign must be submitted with the claim. A

Internet:

E-mail: idr@iowa.gov

power of attorney should clearly identify who is to receive the

refund check and where it should be mailed.

IOWA COUNTIES AND COUNTY NUMBERS

01-ADAIR

26-DAVIS

51-JEFFERSON

76-POCAHONTAS

Supporting Documentation Required Before the Claim

02-ADAMS

27-DECATUR

52-JOHNSON

77-POLK

03-ALLAMAKEE

28-DELAWARE

53-JONES

78-POTTAWATTAMIE

can be Processed

04-APPANOOSE

29-DES MOINES

54-KEOKUK

79-POWESHIEK

05-AUDUBON

30-DICKINSON

55-KOSSUTH

80-RINGGOLD

Retail Sales/Use Tax, Consumer’s Use Tax, Local Hotel/

06-BENTON

31-DUBUQUE

56-LEE

81-SAC

07-BLACK HAWK

32-EMMET

57-LINN

82-SCOTT

Motel, State Excise, and Automobile Rental Tax: Copies of

08-BOONE

33-FAYETTE

58-LOUISA

83-SHELBY

09-BREMER

34-FLOYD

59-LUCAS

84-SIOUX

the invoices, exemption certificates, credit memos, and any

10-BUCHANAN

35-FRANKLIN

60-LYON

85-STORY

11-BUENA VISTA

36-FREMONT

61-MADISON

86-TAMA

other supporting documentation applicable.

12-BUTLER

37-GREENE

62-MAHASKA

87-TAYLOR

13-CALHOUN

38-GRUNDY

63-MARION

88-UNION

14-CARROLL

39-GUTHRIE

64-MARSHALL

89-VAN BUREN

Fuel Used in Processing and Implements of Husbandry: A

15-CASS

40-HAMILTON

65-MILLS

90-WAPELLO

16-CEDAR

41-HANCOCK

66-MITCHELL

91-WARREN

processing vs. nonprocessing energy study to determine the

17-CERRO GORDO

42-HARDIN

67-MONONA

92-WASHINGTON

18-CHEROKEE

43-HARRISON

68-MONROE

93-WAYNE

exempt percentage, copies of all invoices, and a schedule of

19-CHICKASAW

44-HENRY

69-MONTGOMERY

94-WEBSTER

20-CLARKE

45-HOWARD

70-MUSCATINE

95-WINNEBAGO

energy used. Explain the manufacturing process (how the

21-CLAY

46-HUMBOLDT

71-O’BRIEN

96-WINNESHIEK

22-CLAYTON

47-IDA

72-OSCEOLA

97-WOODBURY

equipment using the fuel is used in this process) and describe

23-CLINTON

48-IOWA

73-PAGE

98-WORTH

24-CRAWFORD

49-JACKSON

74-PALO ALTO

99-WRIGHT

the tangible personal property to be sold at retail.

25-DALLAS

50-JASPER

75-PLYMOUTH

22-009b (08/05/09)

Form Ia 843 - Claim For Refund Page 2

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