Form Ia 1040es - Nonresident Request For Release From Withholding - 2012

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2012 IA 1040ES
Iowa Department of Revenue
FOR CALENDAR YEAR 2012 OR FISCAL YEAR ENDING _____________ , 20 _____
I
CALENDAR YEAR
4
INSTALLMENT DUE DATE
Your Social Security Number
JANUARY 31, 2013
Daytime Telephone Number
AMOUNT OF PAYMENT $ _____________________
(
)
-
Mail to:
Estimate Processing
Iowa Department of Revenue
PO Box 10466
Make check or money order payable to "Treasurer - State of Iowa"
45-002 (06/22/11)
Des Moines, IA 50306-0466
Or pay online at
2012 IA 1040ES
Iowa Department of Revenue
FOR CALENDAR YEAR 2012 OR FISCAL YEAR ENDING _____________ , 20 _____
I
CALENDAR YEAR
3
INSTALLMENT DUE DATE
Your Social Security Number
OCTOBER 1, 2012
Daytime Telephone Number
AMOUNT OF PAYMENT $ _____________________
(
)
-
Mail to:
Estimate Processing
Iowa Department of Revenue
PO Box 10466
Make check or money order payable to "Treasurer - State of Iowa"
45-002 (07/14/11)
Des Moines, IA 50306-0466
Or pay online at
Instructions
44-017b (08/05/11)
In general, if paying a nonresident an Iowa nonwage payment, Iowa withholding must be withheld at a rate of 5% of
the payment amount. Nonresidents who prefer to make an Iowa estimated payment instead must file this Nonresident Request
for Release from Withholding form. Any income paid in excess of the amount stated will be subject to withholding.
Who needs to file and pay estimates? Anyone who expects to have a tax liability of $200 or more when filing their
Iowa income tax return. The IA 1040ES coupons and instructions are available from our Web site at .
Exempt: Nonresidents who are exempt from filing an Iowa return or from paying estimated tax should check the box.
Tax due: If tax is due, this form must be submitted with the tax due and appropriate IA 1040ES coupon to the Iowa
Department of Revenue. This form must be filed prior to receiving the Iowa-source payment/income.
Mail to: The request for release, payment, and coupon, if applicable, should be mailed to Registration Services, Iowa
Department of Revenue, PO Box 10465, Des Moines IA 50306. Upon receipt of this properly completed form and applicable
payment, the Department will issue a letter to the payer authorizing payment without Iowa withholding.
You must file an Iowa income tax return if:
You were a nonresident or part-year resident and your net income from Iowa sources was $1,000 or more
You were a nonresident or part-year resident and subject to Iowa lump-sum tax or Iowa minimum tax,
even if Iowa-source income is less than $1,000

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