Form 309-6701 - Contractor Registration Application/renewal Form/form 60-0126 - Report To Determine Liability Page 3

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CONTRACTOR REGISTRATION
FEE EXEMPTION APPLICATION FORM
Iowa Division of Labor
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
Phone: (515) 242-5871 or 1 (800) 562-4692
Fax: (515) 725-2427
Email: contractor.registration@iwd.iowa.gov
If all of the following statements are true for you, you qualify for an exemption from the $50 yearly
contractor registration fee. If your business changes so that you no longer meet the exemption requirements,
you must immediately forward the fee to the Division of Labor. If you qualify as fee exempt, sign below and
have your signature on this form notarized. Attach an additional sheet for employee data, if necessary.
l I am a self-employed contractor.
l I do not pay more than $2,000 per year for all employees combined (not including myself.)
l I never perform construction work with or for other contractors working in the "same phase of construction"
at the job site. The "same phase of construction" is defined as the same type of work, such as masonry,
l
stonework, electrical work or concrete work, etc.
l
l If applicable, I have enclosed a list of all current employees and a list of all employees who have worked
for me for the past 12 months and the amount paid to each employee.
l
Contractor's Signature (only if applying for fee exemption)
Date
Notary Signature (only if applying for fee exemption)
Date
Please review for accuracy and return with the correct fee.
Remember: Changes in any of the information on this form must be promptly
reported in writing to the Iowa Division of Labor.

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