Form 32-041 - Corporation Tax Credit For Third Party Sales Tax Application Page 2

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I, the undersigned, declare under penalty of perjury that I have examined this claim,
including all accompanying schedules, documentation, and statements, and, to the best of
my knowledge and belief, it is a true, correct, and complete claim.
Signature(s)
Date
Title
Please mail the completed form and requested information to:
Iowa Department of Revenue
Field Audit
P.O. Box 14454
Des Moines, IA 50306-3454
32-041b (01/02/2015)

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