Form Ia 1040es - Nonresident Request For Release From Withholding - 2012 Page 2
ADVERTISEMENT
1
22012 IA 1040ES
Iowa Department of Revenue
FOR CALENDAR YEAR 2012 OR FISCAL YEAR ENDING _____________ , 20 _____
I
CALENDAR YEAR
2
INSTALLMENT DUE DATE
Your Social Security Number
JULY 2, 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
2012 IA 1040ES
Iowa Department of Revenue
FOR CALENDAR YEAR 2012 OR FISCAL YEAR ENDING _____________ ,20 _____
I
CALENDAR YEAR
1
INSTALLMENT DUE DATE
Your Social Security Number
APRIL 30, 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 (06/22/11)
Des Moines, IA 50306-0466
Or pay online at
Iowa Department of Revenue
2012 Nonresident Request for Release From Withholding
44-017a (06/22/11)
For calendar year 2012 or fiscal year beginning ________________ , __________ and ending ________________ , ___________
Social Security Number
Daytime Telephone Number
Name
City
State
Zip Code
Number and Street or Rural Route
Income from Iowa source(s).
Iowa Estimated
Iowa Estimated
Name and Address of Payer
Gross Income
Related Expenses
Net Income
a)
a) ___________________________________________________________________________________________________________________________________________
b)
b) ___________________________________________________________________________________________________________________________________________
Total Estimated Iowa Net Income:
Exempt: Check this box if you are exempt
Tax Due: Check this box if tax due
Add net income on lines a and b.
from paying Iowa estimated tax.
and an IA 1040ES are attached.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial